Ryan budget criticized for potential cuts to nursing-home care

While House Budget Committee Chairman Paul Ryan (R-Wis.) is pitching his Medicaid overhaul as welfare reform, healthcare providers and liberal groups are warning that its greatest impact may be on seniors.

Because Medicare does not cover long-term care such as lengthy nursing home stays, some 14 million seniors and people with disabilities instead rely on Medicaid. The nursing home and assisted living industry is raising that concern in a yet-to-be-released statement from former Gov. Mark Parkinson (D-Kan.), obtained by The Hill.

"One million patients require long term care through Medicaid every day," Parkinson, the president and CEO of the American Health Care Association, said in the statement. "In 2010, Medicaid underfunded nursing facilities by $5.6 billion, or $17 per patient, per day. We owe it to these patients to find a workable solution while still meeting their critical care needs."

Liberal groups have raised similar concerns.

"Don't discount Medicaid's importance for the middle class," Michael Linden of the Center for American Progress wrote in a Monday preview of the Ryan budget. "It is often thought of as a program for the very poor, but it covers the costs of nearly two-thirds of all nursing home residents — many of whom only became poor as they spent their resources on long-term care."

Ron Pollack, executive director of Families USA, made the same argument Tuesday.

"The House Republican budget proposal should be accompanied by a 'Grandma Beware!' sign," Pollack said in a statement. "The proposal will inevitably result in seniors losing the nursing home and other long-term care they need at a time when they are most frail. In addition to hurting seniors when they are most vulnerable, younger family members will need to give up their jobs so they can take full-time care of their parents and grandparents."

Ryan doesn't address long-term care in his 73-page Roadmap. Instead, under the heading of welfare reform, he proposes reducing federal Medicaid spending by $771 billion over a decade and turning it into a block-grant program.

Ryan's 2012 budget proposal would also replace Medicare with premium subsidies paid directly to a choice of private plans, but those plans are seen as unlikely to cover long-term care.

"I haven't seen or heard anything about adding [long-term care] in the mix," said one long-term-care industry official. "It's difficult to structure a benefit, and expensive."

Ryan also wants to eliminate the healthcare reform law's long-term-care entitlement, without proposing a replacement. 

The Community Living Assistance Services and Support (CLASS) Act seeks to create a voluntary employer-based long-term-care insurance program to supplement the private market. More than 60 percent of seniors will need long-term care in their lifetime, according to AARP, but only about 8 million Americans have private coverage. But Republicans argue CLASS Act is unsustainable, and Ryan's budget proposal would repeal it along with the rest of the healthcare reform law.

The long-term care official tells The Hill that the industry will also be monitoring Ryan's Medicare proposal. Stakeholders hope those private plans will cover the first 100 days of nursing and rehabilitation stays, just as Medicare does now.

"While there's a long ways still in this process, we're watching to ensure that any plans available to Medicare beneficiaries under a premium support model would provide the same core benefits as fee for service such as post-acute care," the official said. "That care is so important to a senior who, say, falls and breaks a hip. When you think about true care coordination to ensure seniors are in the most appropriate care setting to keep costs down, nursing and rehab facilities must play a role."