Nursing homes in Illinois face a Medicaid funding crisis.
In 2018, Illinois ranked 49th in the nation for Medicaid reimbursement to skilled nursing facilities. Failure to invest in health care for the frail elderly creates dire consequences for residents and the staff who work hard every day to provide quality care. It costs approximately $70,000 a year to care for a skilled nursing facility resident. But Medicaid reimburses approximately $55,000, causing an annual shortfall of $15,000 per resident per year. Senate Bill 42 and House Bill 224 seek a remedy.
We are requesting support from elected officials to close the funding gap between actual cost of care and Medicaid reimbursement.
Illinois also needs to eliminate mandatory managed care for skilled nursing facility residents. Managed care organizations (MCOs) are creating barriers to access for the infirmed elderly who call skilled nursing facilities their home. MCOs require prior authorizations that delay vital health care services, such as medications and therapies. Many doctors decline to care for nursing home residents who have managed care, causing residents to lose long-standing relationships with health care providers. MCOs also have unchecked authority to deny claims, creating further stress on underfunded skilled nursing facilities. Senate Bill 43 and House Bill 1603 seek to eliminate managed care for nursing home residents.
Medicaid reimbursement rates do not cover the actual cost of care for Medicaid residents in skilled nursing facilities.
Research shows the average cost of care for a resident with Medicaid exceeds the average reimbursement rate by approximately $41 a day.
In Illinois, it costs an average of $70,000 per year to care for a skilled nursing resident, but the state only reimburses an average of $55,000.
A recent statewide survey shows 86% of respondents think adequate Medicaid funding for skilled nursing facilities holds the same importance as other Illinois funding priorities, including education.
In the last two years, 13 skilled nursing facilities closed, with many more in danger of closing.
Illinois is facing a workforce shortage in long term care, demanding sign-on bonuses of up to $5,000 for CNAs and $15,000 for RNs.
The current Medicaid support rate for skilled nursing facilities is based upon 2004 costs, not accounting for inflation or increased costs.
Illinois can no longer rely on Medicare reimbursement rates to supplement low Medicaid reimbursement rates because Medicare rates, occupancy and length of stay have decreased.
The Health Care Council of Illinois (HCCI) is committed to supporting nursing home communities across the State. We work closely with policy makers and health care professionals to support legislation that benefits nursing home communities, and actively strive to defeat any legislation that could have a negative impact on those we serve.