Can’t seniors and their families already choose whatever skilled nursing facility they want?
For now, yes. But unless action is taken, by Sept. 1, 2017 vulnerable seniors across the state could be displaced from the skilled nursing facility they now depend on.
The Texas Legislature passed Senate Bill 7 in 2013, mandating nursing home residents whose care is funded by Medicaid enroll in a managed care organization. This legislation wisely included several protections for seniors, including ensuring them the freedom to choose the facility that keeps them close to family and best meets their needs. This was accomplished by requiring that any facility licensed to care for residents on Sept. 1. 2013 could not be excluded from a provider network, if they maintained their license. That protection expires on Sept. 1, 2017.
Why is this happening?
Profit, not quality of care, is behind the possible expiration of this protection. The for-profit managed care organizations now administering the Texas Medicaid program will make more money if they can narrow the network of providers with which they do business.
Who will be affected?
Letting this protection expire could affect vulnerable seniors and their families across the state. But it could hit rural Texans especially hard, forcing family members to drive long distances to maintain regular visits with their loved ones when their hometown nursing home is squeezed out of a managed care provider’s network.
Who is making the rules here?
If this protection expires, the five managed care organizations who manage the state’s Medicaid and Medicare program would be. Families — not out-of-state actuaries — should be able to choose the nursing home that works best for them. And skilled nursing facilities who meet all state and federal requirements should be able to provide care for Texas’ Medicaid residents.
What can be done?
Without action from the 85th Legislature, the freedom of choice protection for nursing home residents ends on Sept. 1, 2017. By making the freedom of choice protection permanent, the state can avoid the turmoil that will follow if it expires.
What will it cost the taxpayers?
Making the freedom of choice protections now available to seniors permanent will have zero impact on the state’s general revenue.