The nursing homes that reject hundreds of debilitated low-income Medicaid patients claim that they are "unable to safely meet the patients' needs," but an ongoing investigation by the Seattle Times indicates a more sinister reason these patients occupy Washington state hospital inpatient beds for months on end: They are "medically undesirable" just by virtue of being part of a growing population of seriously ill or disabled residents who receive Medicaid, the government's insurance program for the poor.
The newspaper reports it found at least 2,025 such cases from 2000 to 2008, with an overall price tag--written off as charity care and passed on to those who pay--of $461 million. At Harborview Medical Center, for example, a 62-year-old cardiac patient waited 234 days, during which the hospital tallied $1 million in uncompensated expenses, before a Seattle nursing home agreed to take him in.
But while operators of nursing- and adult-care homes admit that they often lose money on Medicaid--which reimburses as little as one-tenth of the amount paid by private insurance--they contend that they don't illegally deny care based on patients' incomes. According to Terry Marker, assistant director of Home and Community Services Division at DSHS, few long-term-care facilities are staffed or trained to deal with patients who have both the serious mental and physical disabilities often seen in these cases. "In the long term, we are going to have to get specialty homes. We are going to have to work with and recruit providers who are willing to provide this care--and we will have to pay them."
In the meantime, DSHS officials warn that unprecedented numbers of seniors on Medicaid will flood the healthcare system in the next 15 years. "The issue here is 'Where do they all go?'" said Richard Kellogg, director of Integrated Health Services at DSHS.
To learn more:
- read this Seattle Times piece