sad man being comforted
(Credit: Goodboy Picture Company/Getty Images)
sad man being comforted
(Credit: Goodboy Picture Company/Getty Images)

A Pennsylvania legislator has proposed a bill that would allow assisted living communities to become Medicaid-eligible providers, and the results of a new member survey from the Pennsylvania Health Care Association show how the bill could benefit residents, providers and the state.

Senate Bill 520, introduced last week by state Sen. Michele Brooks (R), also would include licensure waivers to enable personal care homes in the state to convert to assisted living residences to care for Medicaid-eligible residents. PHCA supports the bill.

“Allowing Medicaid to cover the cost of care in assisted living would not only allow a resident to age in place, but it would also benefit Pennsylvania financially at a time when we are preparing to face an eventual fiscal cliff,” PHCA President and CEO Zach Shamberg said in a statement.

In Pennsylvania, senior living services in assisted living and personal care settings are not eligible for Medicaid payments to cover costs, so when a resident no longer can afford to privately pay for care, the resident is discharged to another setting, often a more expensive nursing facility, where Medicaid can cover the costs, even if the resident’s care needs can be met via assisted living or personal care.

“This is less about access to care and more about maintaining the right level of care in an environment that our residents call home,” Shamberg said.

The PHCA survey was conducted digitally Feb. 6-17 and included 31 executive directors and eight facility owners. 

According to the executive directors participating in the survey, assisted living communities and personal care homes in the state discharged an average of eight residents each in 2022 because the residents no longer had enough funds to pay for services. With 1,138 assisted living communities and personal care homes in the Keystone State, the figure works out to more than 9,000 residents being discharged in 2022 because they ran out of money, PHCA said.

Poll participants said that the top reason residents transferred out of assisted living or personal care was that they needed skilled nursing care, but the No. 2 reason was that they no longer could afford to privately pay. (No. 3 was that they moved or relocated to another residence, and No. 4 was that services no longer were needed.)

Waiting lists for Pennsylvania assisted living communities and personal care homes are even longer than those for nursing homes, according to the survey results. On average, 3.5 people are waiting to move into a senior living setting, which statewide equals approximately 4,000 people. Nursing homes, on the other hand, have waiting lists that average three people per facility, or a total of approximately 2,000 people statewide, according to survey results.

By forcing assisted living and personal care home residents to move, “with thousands of residents already waiting to be admitted into nursing homes,” Shamberg said, “we are only further exacerbating the issue and overwhelming the system.”

Ninety-four percent of the assisted living and personal care executive directors surveyed said their communities have residents who would benefit from Medicaid coverage. Thirty-five percent said that they have 21 or more residents, each, in their buildings who would benefit from Medicaid covering the costs of services each year.

Sixty-three percent of surveyed assisted living community owners said that if Medicaid funds were available for licensed assisted living residences in Pennsylvania, they likely would admit or continue caring for residents who rely on Medicaid to cover resident care service costs. Additionally, 38% of personal care home owners surveyed said they would at least be somewhat likely to pursue an assisted living community license to become eligible to serve residents who rely on Medicaid to cover resident care service costs.

PHCA is the state affiliate of the American Health Care Association/National Center for Assisted Living. A recently released white paper by NCAL asserts that the Medicaid program is one of the major challenges to the provision of affordable assisted living. At issue, the paper states, is chronic underfunding of the program and its access limitations to assisted living care.

According to NCAL, nationally, 48% of assisted living communities are Medicaid-certified as home- and community-based service providers, and almost 17% of residents nationally rely on Medicaid to cover daily care in assisted living.

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