Illinois puts its own spin on hammering out healthcare financing provisions each year and Monday signaled the start of another good outcome for long-term care operators, a top provider exec said.
The state’s 2024 Medicaid Omnibus package became immediately live Friday, bringing plums such as a fix to how a major payment methodology is calculated, about $38 million in annualized property relief for providers and a cache of other sweeteners, such as more dialysis reimbursement to nursing homes.
“Though there can always be more funding and additional considerations included, this year’s legislation is good news for providers,” Illinois Health Care Association President and CEO Matt Hartman told McKnight’s Monday.
For at least a decade, Illinois has put almost all of its Medicaid funding considerations into an omnibus bill hashed out by a broad working group. This has helped streamline considerations and cut out a lot of fighting for figurative slices of the funding pie, Hartman said.
This year’s overall Medicaid uptick was expected to be about $100 million, and most of it would be dedicated to smaller groups, he explained.
“We took in more than [$100 million] in each of the last few years on our own,” he recalled. “To get $25 million to $30 million of it [in the coming fiscal year] is a pretty good year. Hospitals, I don’t think, saw anything in the package, so we felt good about what we were able to capture.”
“The vast majority of providers do well under the new (methodology) — they maintain or increase their funding,” he added. “Our methodology has a moving target for the ultimate budget number. As your acuity goes up, your rate can go up or down, depending on how you have to staff. It really goes to the methodology.”
Assisted living, senior living and developmentally disabled providers also received boosts including codification of language to support meal costs, a personal needs allowance increase, and further language on the dementia care application process. There also were updates to bed hold language and wage increases, Hartman said.
Mental health funding changes will pave the way for more single rooms, and fund a bed reduction program.
Dialysis boost
While the dialysis funding wasn’t a major plank the IHCA focused on, Hartman said, it is something that can help many.
“It offers an ancillary service option for providers, which is valuable as providers contend with low rates and still look to see occupancy fully rebound,” he noted. “It also offers benefit as an opportunity for residents to be able to take advantage of the service without having to transport two ways and sit in an uncomfortable situation.”
Dialysis as an added option may be more likely to occur in areas with denser populations, he observed.
The property tax breaks will be especially helpful in the northern part of the state, where rates are highest and can’t otherwise be offset with public funding.
As always, there’s still more work to do, Hartman reminded.
“There’s always room for improvement. We know we’re underfunded to the tune of $400 million in the next fiscal year, and it will climb to over $500 million — we know that from cost report data,” he said. “We need to see continued investment. And see that through our rates.”
Peer advice
Hartman’s tenure with IHCA extends back 20 years. He said state provider leaders have gradually learned how to “do rate methodology revisions better.”
“Collegiality is always going to be important,” he observed. “When the state gives you a pie for four people and you have to feed 12 people, you have to be creative. I think our ability to rely on data, rely on outcomes and feel the winds of change and apply the metrics the public wants to see while also being cognizant of what’s happening in facilities and what providers are feeling … there’s a really small needle to thread, and I think we’ve done well with it.”
He said being able to work with unlikely or “unusual” partners also has been key.
“We’ve developed a great relationship with our payor agency. We don’t always agree with them, but we converse well, we have mutual respect and trust, and we have a mutual reliance on the usage of data as a driver for how well you reimburse well,” he noted.
“We worked collegially with SEIU and the AARPs of the world to pass methodology that was meaningful for providers but also drove good resident outcomes,” he added. “I think more and more states are going to have to grapple with those kinds of intricacies to pass meaningful change. They can’t set them aside.”
