It still looks like a bit of business is going to be completed before the nursing home staffing mandate is completely amortized, but don't let it be too distracted from more important topics.
Payment for providers has always been an important consideration for anyone in the business. There's a problem first.
Medicaid has been the dominant payer of U.S. nursing home services for many years. Simply put, if Medicaid already had inadequate payment levels, the nursing home sector would be far worse than the demands of larger staffing levels.
In the latter case, it is the matter of placing a qualified body at the bedside or paying enough to reduce services otherwise. The conclusion and owner's rainy day fund may take a bet, but life continues.
But if lawmakers and the White House moved to significantly hinder Medicaid funds that give so many operators a lifeline, well, now we're in another universe. Call 911 and realize that breaking the paddle may not be enough.
If there's nothing else, take your cues from two major American Nursing Home Associations that have already issued eye-opening warnings about the future of Medicaid payments.
On Thursday, House Speaker Mike Johnson (R-LA) overcomes stubborn people in his own party to narrowly pass a budget bill that demands $1.5 trillion in federal spending cuts. Critics said Medicaid funding to long-term care providers is no way to harm them if the Senate, which is currently miles away with funding cuts, agrees to similar terms.
In a typical Washington political twist, the fate of Medicaid funds in the sector and the fate of the ultimate end of nursing home staffing may be dangerously intertwined.
Power play
One theory is that the Trump administration has yet to abandon its outward support for staffing mandate because it wants to make better use of its providers with potential Medicaid cuts.
Legal experts have storyboarded a Quid Pro Quo that does something like this. Do you want us to stand up and not to reject staffing duties in Texas? Okay, then you'll leave our Medicaid targeting alone.
That may sound a bit far away, but how quirky can it be than this administration's lawyer who has been firmly listening to their support for the Joe Biden-led staffing mission last week? It happened. Think about that.
My money for the Trump administration ultimately passed the appeal window in a few months, but only after a stressful blinkmanship. It will then be up to Congress to decide whether to insert provisions to kill staffing mandates in a massive spending bill.
There should be enough combinations of votes from both sides of the aisle to get it done, but who knows a power broker who can knuckle under Congressional leaders, whether they like it or not?
A wide variety of healthcare providers and stakeholders have already protested the idea of reducing Medicaid for some time now. So this fight isn't the only long-term care provider.
Again, the dog's hungry pack knows to see its members attract each other. Divide-and-Croul is a well-known strategy in the Washington Playbook.
So, no, it's not a good time for providers to take their eyes off Medicaid-related stuff. It is not necessarily important whether the facility relies on Medicaid as the dominant source of funding. Too many operators in the sector.
If the final weeks of politics have taught us anything, then it means that, for some important interests, you have to consider the big picture along with what you have in your own backyard.
James M. Berklan is the executive editor of McKnight's Long-Term Care News and is the best commentary award winner at the 2024 NEAL Awards, and is given to the best specialized business journalism each year.
The opinions expressed in McKnight's long-term care news column are not necessarily those of McKnight.
