As the United States surpasses 500,000 COVID-19 deaths, many Texans are mourning the loss of a loved one or close friend. Since the very first outbreak, we have seen how devastating the virus is, especially to long-term care facilities, the Texans who live there and the professionals who work in them. Unfortunately, despite vaccine rollouts and a decrease in infection and death rates, long-term care facilities are bracing for another devastating blow: the loss of vital emergency funding that has helped address the increased costs of care in the new COVID-19 world.
Thanks to the state Legislative Budget Board (LBB), long-term care facilities are currently receiving a higher Medicaid reimbursement rate to help address the increased costs associated with COVID-19 for the two-thirds of Texans in skilled nursing facilities whose care is paid for by Medicaid. The increased funding has been used to procure personal protective equipment (PPE), maintain compliance with state and federal regulations, maintain staffing, comply with regular testing requirements, and address infection control requirements, all to provide the quality of care our residents deserve, not to mention the 15-20% loss in census realized by most providers.
However, this added reimbursement only lasts while the federal public health emergency (PHE) is in place. COVID-19 and all the additional costs associated with it do not go away with the end of the PHE declaration. Testing will continue, PPE requirements will continue, staffing shortages will continue. And it will take months, if not years, for census to rebound. All the additional cost items will remain, yet funding will decrease without legislative intervention.
We as long-term care providers in Texas are no strangers to fiscal challenges. Texas ranks second-worst in the nation in the Medicaid reimbursement rate, at a staggering $32 per resident, per day, below the cost to care for that Texan. It’s been almost 20 years since Texas covered a resident’s daily care cost. This means that facilities lose money when caring for Texans who require 24-hour care.
Continuous underfunding has caused a number of crises for long-term care in Texas, which has only been exacerbated by COVID-19. We have worked hard to comply with constantly changing federal and state infection-control requirements designed to keep residents safe. Without the emergency funding, we likely would not have been able to afford to comply. Underfunding has exposed the struggles to attract and maintain the necessary workforce to properly care for our seniors in Texas. Staff can make more money in other, higher reimbursed health care settings or can no longer work at more than one facility mandated by state and federal guidelines. Facilities are operating three nursing units inside of one facility due to state and federal guidelines. This has exponentially added cost to the underfunded Medicaid system. Many cannot provide for their own families while working in long-term care. Others made the decision to quit entirely due to the high risk of COVID-19. Workforce markets have become even tighter due to COVID-19.
The LBB’s emergency added funding has been critical and has helped provide much-needed and much-appreciated relief for the often-overlooked long-term care facilities. With vaccinations and the current emergency funding levels, there is light at the end of the tunnel — unless this crucial funding is allowed to expire just as we get our feet back under us.
It goes without saying how devastating the loss of this emergency Medicaid funding will be for long-term care. At the very least, we must preserve the add-on through the 2022-23 budget cycle to provide the best care for elderly Texans in the short term. While COVID-19 may one day be a distant memory, many infection control practices will continue to help protect residents and elevate their care into the future. With the funding increase already in place and aiding facilities, it has never been an easier or better time to do what is right, and that is to do right by Texas seniors.