Medicaid—Protecting Seniors by Improving Safety and Quality of Care in Nursing Homes

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Millions of Americans, including children, non-elderly adults, and older adults, need long-term services and supports (LTSS) because of disabling conditions, chronic illness, and other factors. Medicaid, which is the primary payer across the nation for these services, allows for the coverage of LTSS through several authorities and programs and over a continuum of settings, ranging from institutional care, such as in nursing facilities, to home and community-based services (HCBS). The Biden-Harris Administration, including CMS, is committed to ensuring that all older adults and people with disabilities have access to high-quality services in the setting of their choice.

Over the last decade, CMS and states have worked and continue to work closely together to reduce reliance on institutional services and expand access to high-quality HCBS. Today, most Medicaid LTSS spending is on HCBS, accounting for $125 billion, while institutional services accounted for $75 billion in Medicaid expenditures in 2020. In February 2022, the White House and CMS announced a comprehensive set of reforms to improve safety and quality of care in our nation’s nursing homes through the action plan “Protecting Seniors by Improving Safety and Quality of Care in the Nation’s Nursing Homes” (Biden-Harris Administration’s Nursing Home Reform Action Plan).

Improving health equity in nursing facilities is a priority for CMS to not only improve the quality of care, but also the quality of life for nursing home residents. Medicaid is a key lever for accomplishing the goals of strengthening the quality of care, accountability, and transparency.

States can implement a number of initiatives immediately through the Medicaid state plan, waiver, or demonstration process, which are highlighted below. Through initiatives like these, we expect that Medicaid beneficiaries residing in nursing facilities will receive better care through the collaboration of CMS and states to realize the goals outlined in the White House Biden-Harris Administration’s Nursing Home Reform Action Plan.

CMS is launching new initiatives in both Medicare and Medicaid to ensure that nursing facility residents get the quality care they need. These initiatives are intended to help ensure adequate staffing, dignity, and safety in resident accommodations, as well as high-quality care, including establishing a minimum nursing home staffing requirement; undertaking efforts to reduce resident room crowding; strengthening the Medicare Skilled Nursing Facility (SNF) ValueBased Purchasing (“VBP”) program, and reinforcing safeguards against unnecessary medications and treatments.

For more information, view the entire Center for Medicaid & Chip Services document here:

https://www.medicaid.gov/federal-policy-guidance/downloads/cib08222022.pdf

The high cost of nursing home care has made long-term planning a critical issue for nearly all middle-class seniors and their families. A senior’s savings can be depleted very quickly, leading to financial crisis. One way to address this kind of concern is through proper Medicaid planning with the help of an experienced lawyer. The Law Office of Scott C. Painter, P.C. will leverage over 25 years of experience to assist you with your planning process!

The law office of elder law attorney Scott C. Painter, P.C., is located in Wyomissing (outside of Reading, PA, in Berks County,) and offers trusted legal services in the areas of elder law, including nursing home planning, trust and estate services, and veterans benefits. Scott C. Painter is a Certified Elder Law Attorney (CELA®), and he is also a member of the National Association of Elder Law Attorneys (NAELA). 

If you have an issue or question, we encourage you to call us. With legal matters, time is of the essence. Call us for a consultation at 610-378-5140. The $300 consultation fee is waived if Attorney Painter is retained to perform services.

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