Latest in a series of columns answering consumers’ questions about California’s changing medical landscape.
By Emily Bazar
Most everyone agrees that it can be very difficult – next to impossible, really – for Medi-Cal enrollees to snag a spot in a nursing home, especially if they’re transferring from their homes or assisted living facilities rather than going straight from the hospital.
Not everyone agrees on the reasons, however.
“There’s massive, systemic Medi-Cal discrimination,” says Pat McGinnis, executive director of California Advocates for Nursing Home Reform. She believes some nursing homes illegally turn away enrollees because they don’t want to accept Medi-Cal’s lower reimbursement rates.
“If they can get more money with private pay or Medicare, they would rather accept one of them,” she says.
Deborah Pacyna, director of public affairs for the California Association of Health Facilities, which represents most of the state’s standalone nursing homes, says it’s illegal for nursing homes to discriminate based on payment type. She blames access problems on the state’s rapidly aging population.
“Projections are that we will run out of nursing home beds by 2020,” Pacyna says. “That is putting even more pressure on the Medi-Cal population.”
No matter what you believe, the situation amounts to a crisis for Californians who desperately need a nursing home and are covered by Medi-Cal, the state’s version of the federal Medicaid program for low-income residents, says Susan Geffen, of Hermosa Beach, an elder law attorney, gerontologist and author of a book called “Take That Nursing Home and Shove It!”
If you think low-income doesn’t mean you, think again. Many middle-class Californians need Medi-Cal to help pay for their long-term care because they run out of money paying the bills on their own, she says.
Despite the access challenges many Medi-Cal enrollees face, about two-thirds of California’s nursing home residents rely on the program to cover all or part of their costs.
The state Department of Health Care Services (DHCS), which oversees Medi-Cal, says that nearly 90 percent of California’s 1,400 nursing homes accept its enrollees. The department is the only entity I interviewed that “is not aware of Medi-Cal members who are having difficulty finding a nursing home that will accept them.”
Today, I’m offering some advice if you or a loved one needs a nursing home for a long-term stay. It will be…