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Medi-Cal Officials Snub Reforms to Protect Nursing Home Residents from Abuse and Neglect


On March 25, 2010, the California Department of Health Care Services – the State agency in charge of Medi-Cal – issued a report to the Legislature on the feasibility of reforms to Medi-Cal payments to nursing homes. The report largely dismissed a package of critical reforms presented by CANHR, AARP California, Disability Rights California, Ombudsman Services of Northern California, and Disability Services & Legal Center in January 2009. The report raises serious questions about the undue influence of nursing home operators on Medi-Cal officials.

Annual Medi-Cal payments to skilled nursing facilities have increased by $1 billion (nearly 40 percent) since 2004 under a rate system written by the nursing home industry and approved by
the Legislature and Governor. Despite the enormous rate increases, conditions in many California nursing homes remain miserable. Hundreds of facilities have cut staffing, wages and/or services or used the new money to enrich their owners. Nursing home operator profits have skyrocketed during this period. Some of the operators have been charged or convicted of serious crimes.

In 2008, the Legislature ordered Medi-Cal to convene a workgroup and recommend reforms in response to growing evidence that nursing home operators were routinely exploiting the rate system. Medi-Cal missed the March 2009 deadline for its report by more than a year, waiting until now to advise the Legislature of its findings.

Medi-Cal’s report provides virtually no direction on how the rate system should be reformed and, remarkably, has nothing to say about the rise of abuse and neglect in California nursing homes. It cites lack of consensus as a barrier to reform, without noting that the nursing home industry shouldn’t be given veto authority over changes needed to ensure that nursing home residents benefit from the massive public investment in nursing home care.

Although the Medi-Cal report stopped short of rejecting the reforms recommended by advocates, it included baseless objections to virtually all of their recommendations for reform of the reimbursement system.  The commonsense recommendations include:  (1) banning payment of facility attorney fees used to fight citations for abuse and neglect; (2) capping reimbursement for liability insurance so that substandard nursing homes are not immunized from the costs of mistreatment; (3) redirecting profit payments to nursing homes to increase minimum staffing requirements; (4) requiring nursing homes to electronically report payroll data to verify staffing levels; and (5) posting current staffing levels online to inform the public.

Tragically, Medi-Cal is allowing nursing home operators to loot California’s treasury while citing budget problems to justify slashing programs that help people stay out of nursing homes.

CANHR strongly urges the Governor and the Legislature to immediately reform the rate system to ensure that the billions of dollars California is investing in nursing home care are used to improve residents’ care and quality of life.

Click here to read Medi-Cal report.

Click here to read CANHR’s recommendations.