
Indiana nursing homes are navigating a turbulent transition to managed care for Medicaid services, which began on July 1st. This shift has introduced significant financial uncertainties, especially due to delayed reimbursements, leaving many smaller facilities needing help to meet payroll and maintain operations. This article delves into the impact of this transition on nursing homes in Indiana, highlighting the concerns of operators and the broader implications for the industry.
Financial Uncertainties and Delayed Reimbursements
Jeff Huffman, Chief Operations Officer of The Strategies, oversees five nursing home and rehabilitation facilities in Indiana, employing around 300 staff members. Huffman expressed deep concerns over the financial instability caused by delayed Medicaid reimbursements. According to Huffman, facilities operated by The Strategies have been denied payments for over 80% of the services provided by clinicians. While the organization has managed to pay employees thus far, the future remains to be determined.
"Small operators in particular heavily rely on Medicaid reimbursements to keep bills paid and to keep operating," Huffman emphasized. "Timely payments are crucial for maintaining operations."
Emergency Relief Provisions
State law provides emergency relief options during the initial 210 days of the transition period. Providers can seek assistance if claim denials exceed 15% or if payments are delayed beyond 21 days for claims totaling $25,000 or more. However, Huffman criticized the emergency financial assistance program for reimbursing only a fraction of the average claims, likening it to giving insurers a discount on owed payments.
“If they don’t pay by day 30, the emergency clause that kicks in makes them have to pay us 75%,” he said. “It sounds like a 25% profit margin for big insurance.”
Comparison with Other States
In other states where managed Medicaid has been implemented, the program typically applies to only 25% of operators. In contrast, all nursing home operators in Indiana are subject to the managed care system. Huffman pointed out that Indiana had one of the country's most efficient Medicaid reimbursement systems for the last 15 years. However, the state has been pushing managed Medicaid, transferring Indiana Medicaid taxpayer money to managed care providers.
“Indiana had probably the most efficient Medicaid reimbursement system in the country for the last 15 years, and for whatever reason, for the last three years, they’ve been pushing this managed Medicaid, basically taking Indiana Medicaid taxpayer money and giving it over to [managed care providers],” Huffman said.
Insurance Companies and Claims Portals
Anthem Blue Cross Blue Shield, Humana Healthy Horizons in Indiana, and United Healthcare Community Plan are some insurance companies that manage Medicaid in Indiana. Paul Peaper, President of the Indiana Health Care Association, noted that several facilities have encountered challenges with the new managed care system’s claims portals.
“We’ve got three different managed care entities all with their own claims portals. As you’re submitting your claims into each of their claims portals, it looks different and reports out different information at different times,” Peaper explained.
The Path Forward
To address these challenges, nursing home operators in Indiana must navigate the complexities of the new managed care system, ensure timely submissions, and adapt to different claims portals. Advocacy for clearer guidelines and more consistent reimbursement processes is crucial. Additionally, operators should explore emergency relief options and seek collaboration with state authorities to improve the managed care system.
Conclusion
The transition to managed care for Medicaid services in Indiana has introduced significant financial uncertainties for nursing home operators. Delayed reimbursements and complex claims portals have created substantial operational challenges, particularly for smaller facilities. As the industry adapts to these changes, continued advocacy and collaboration with state authorities will ensure financial stability and continued high-quality care in nursing homes across Indiana.
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