Massachusetts (again) sounds alarm for America. (NH News Notes).

Massachusetts providers might want to consider a modern-day "Boston Tea Party" to stress the state's dire underfunding of long-term care and its consequences. Legislators, providers and nursing home residents' family members recently gathered at Hancock Park Rehabilitation and Nursing Center in Quincy (part of the Welch Healthcare and Retirement Group) to discuss the crisis, as reported in the Spring 2002 issue of Welch Healthcare's newsletter, The Welch Connection.

"The state must recognize its responsibility and increase Medicaid reimbursement rates for the state's nursing homes so that we can continue to provide quality care," Paul Casale, vice-president of Welch Healthcare, said in the article.

The cosponsor of the event, the Massachusetts Extended Care Federation (MECF), highlighted the state's long-term care funding problems in an April 2001 report titled, Where Will Your Mother Go?

Among the findings was that Massachusetts ranked third from the bottom of all states and Washington, D.C., in average nursing facility profit margin, according to the 2000 Guide to the Nursing Home Industry. The report also stated that "As a result of the state's persistent ratcheting down of Medicaid rates throughout the 1990s, most Medicaid-certified nursing facilities now receive daily Medicaid rates that average fifteen to twenty dollars per day below allowable cost." At the time of the report, 70% of residents had their care paid for by Medicaid.

This funding crisis is affecting resident access to nursing homes, as well. The Welch Connection article and a release accompanying MECF's report point to a trend in which increasing nursing home closures could eliminate the surplus of nursing home beds in the state within a year. The Welch Connection article points out that in the past three years, nearly 80 Massachusetts nursing homes have closed, so perhaps it is no surprise to learn that in 1999 the industry had its largest single-year loss since Medicare and Medicaid were introduced, according to the MECF report.

Even the state's own Finance Working Group of its Health Care Task Force said "...that the financial condition of the nursing home industry is serious, that there is no reason to expect improvement soon, and that the potential for quality of care to deteriorate due to financial pressures and the difficulty in attracting and retaining staff is real and a cause for concern" (quoted in the MECF report).

To provide some relief, a plan passed by the Massachusetts House--and endorsed by MECF--would increase Medicaid reimbursement for facilities by charging nursing home residents a daily $10 "user fee" and thereby leveraging matching federal funds. Private-pay facilities would have to determine how much of the fee to pass onto residents, while Medicaid would cover the costs for its beneficiaries.

Medicaid underfunding certainly is not unique to Massachusetts, and a bill (S. 2570) recently introduced by Senators Ben Nelson (D-Nebr.) and Susan Collins (R-Maine) aims to temporarily increase the federal medical assistance percentage for Medicaid and other purposes. Reflecting on the nation's Medicaid situation in a statement outlining the Nelson-Collins bill, AHCA's Dr. Roadman said, "Looking cumulatively at the Medicaid underfunding crisis and state budget red ink, there's no question that seniors in state after state are increasingly at risk of losing access to essential healthcare services," adding that "Both short- and long-term steps are necessary to strengthen Medicaid and protect our elderly, and the Nelson-Collins bill is a first step to doing just that."