Lawmakers find way to improve state’s long-term care

In an era of cynicism, it’s fashionable to criticize government’s failings. But what of its successes?

With the Legislature besieged by $100,000 daily fines for K-12 underfunding, it still managed to fulfill a commitment it made last year to reform the Medicaid reimbursement system for roughly 10,000 nursing home patients. It brought together a rare, almost unanimous, coalition of Democrats and Republicans, as well as the leading long-term care union and provider associations.

Under this new system, a minimum staffing ratio in direct care has been established. Eventually Washington will be among the top-five states for staffing requirements. We can only hope the state honors its moral commitment to fund the Medicaid share-of-cost for this costly new expectation, as it has a tendency to cut and run anytime fiscal adversity shows up.

Nursing home care was neglected since the advent of the “Great Recession,” with cost-based reimbursement long marooned upon 2007 costs. The new system should mean an average funding improvement of $16.72 more per patient, per day — a significant improvement, to be sure, even if far less than what neighboring Oregon pays. And the medical need of Washington’s patients exceeds those of any other state except Maine.

There are still perils. The six nursing homes in Skagit County, for example, face being bankrupted by a fluke in the federal Medicare payment system that the Obama Administration has refused to fix despite letters of concern from our two United States senators, governor, all nine state legislators representing Skagit County and other community leaders.

Long-term care advocates should also worry about how state government finds new billions of dollars next year for K-12 education. The time of Band-Aids through smoke and mirrors, including raids on dedicated funds, is over. The last revenue forecast reduced resources by $67 million for the current budget cycle and $442 million for the 2017-19 biennium.

Real tax reform must occur lest care for our most vulnerable is starved to find K-12 funding.

Nursing home providers did their share by paying a provider tax to generate additional Medicaid funding. It would be helpful to reduce pressure on the state budget further, and a study underway (with results to be shared with the 2017 session) may hold the key.

The more promising of two options being modeled is a public long-term care benefit for workers, funded through a payroll deduction (similar to Medicare’s).

For the present, Washington is doing a fairer job of funding both ends of the long-term care continuum — in-home care and nursing homes — with more work needed to maintain the viability of the Medicaid care between those two settings (for example, poor assisted living facility rates). It is a step forward worth commending.

This story was originally published March 21, 2016 at 1:00 PM with the headline "Lawmakers find way to improve state’s long-term care."