When families in Texas seek quality long-term care for their aging loved ones, they often encounter financial, regulatory, and staffing challenges that make the process difficult. The Long-Term Care Facilities Council has recently provided a set of recommendations to the Texas Health and Human Services Commission (HHSC) to address these issues.
These recommendations impact nursing facilities, assisted living facilities, and intermediate care facilities for individuals with intellectual disabilities. At Senior Living Specialists Dallas, we believe it is essential for families to understand these proposals and how they could improve the care and financial stability of long-term care services in Texas.
Addressing Financial Barriers for Families and Facilities
One of the council’s key recommendations is ensuring that Medicaid better supports dual-eligible residents, those who qualify for both Medicare and Medicaid. Currently, many long-term care facilities struggle financially because Medicaid does not reimburse the Medicare copayment for residents who have been approved under Long-Term Care Medicaid but do not qualify under the Medicaid Qualified Medicare Beneficiary (QMB) program. Expanding Medicaid coverage to include these costs would relieve the financial burden on facilities and ensure that residents receive consistent, high-quality care.
Additionally, Texas has one of the lowest Medicaid reimbursement rates in the country. Nursing homes are currently paid significantly less than the actual cost of care for Medicaid residents—approximately $115.74 less per day per resident. Fully funding nursing facilities to meet median costs would stabilize the industry and prevent care providers from being forced to cut corners due to financial constraints.
Strengthening Regulation and Provider Support
To ensure fair funding for nursing facilities, the council suggests reinstating statutory regulations requiring HHSC to set minimum reimbursement rates. This measure would prevent private managed care programs from underfunding long-term care providers.
Another major issue is how HHSC handles dispute resolution for nursing homes facing penalties or citations. Currently, even when an independent review organization finds in favor of a facility, HHSC does not always accept the decision. The council proposes legislative action to make independent dispute resolution (IDR) findings binding, preventing unnecessary financial penalties that could impact on the quality of care provided to residents.
The council also recommends modifying Texas’ “double-dipping statute,” which allows HHSC to impose additional penalties on nursing homes even after the Centers for Medicare & Medicaid Services (CMS) has already assessed fines. If enacted, this change would prevent excessive financial penalties that can strain care facilities and lead to closures, reducing care options for families.
Improving Medicaid Accessibility and Staffing Support
One of the most crucial recommendations involves Medicaid eligibility for long-term care residents. The council urges HHSC to seek a waiver from CMS to allow qualified nursing facilities to determine presumptive Medicaid eligibility for elderly and disabled residents while their applications are processed. This change would ensure that seniors in need of immediate care do not face unnecessary delays due to administrative hurdles.
Additionally, the council emphasizes the need to adjust Medicaid reimbursement rates to reflect the increased costs of staffing, food, and transportation. Many facilities struggle to retain caregivers because wages as low as $10.60 per hour are unsustainable. This staffing crisis has led to high turnover, which affects the consistency and quality of care that residents receive. By adjusting reimbursement rates, Texas can attract and retain skilled caregivers, ensuring better stability and improved services for families.
Enhancing Transparency and Timeliness in Long-Term Care Regulation
Families often struggle to navigate complaint investigations and dispute resolutions in long-term care facilities. To address this, the council recommends implementing a standardized timeline for HHSC complaint investigations to ensure timely resolutions. Delays in addressing complaints can compromise the health and safety of residents, so this reform would enhance accountability and responsiveness.
Moreover, the council suggests that HHSC publish the results of Informal Dispute Resolution (IDR) reviews quarterly. This transparency would help families make informed decisions about care providers based on their compliance history and performance.
How These Changes Could Benefit Families
For families with aging loved ones in long-term care, these recommendations could have a significant impact. If implemented, they would:
- Reduce financial burdens on facilities and residents by improving Medicaid reimbursement rates and coverage.
- Enhance the quality of care by increasing funding for staffing, training, and specialized support for individuals with IDD or autism.
- Improve access to care by streamlining Medicaid eligibility and expanding the number of qualified caregivers.
- Ensure greater transparency and fairness in regulatory processes, making it easier for families to assess and choose care providers.
At Senior Living Specialists Dallas, we believe that informed families make better decisions for their loved ones. If you are considering long-term care options for a family member, these proposed changes could shape the future landscape of care in Texas. Stay informed and advocate for policies that ensure seniors receive the quality care they deserve.
