Wednesday, August 4, 2010

Medicaid Budget Cuts at PSI

Because of recent cuts to the Medicaid budget, PSI has recently been subjected to a number of changes. Medicaid pays for the patients to live at this facility, including their medical care, food, and housing (the total is over $400 per day). PSI is also legally classified as a nursing home, so it must follow the government's nursing home regulations and restrictions as well.

About five years ago, the government mandated that Medicaid would not pay for a nursing home patient's cost of living if they had to leave to go to the hospital within the first 30 days of their admission. This ruling is especially harsh at PSI, where patients are actually the sickest when they enter the facility. When patients first get to PSI, their T-cell count may be extremely low, making them susceptible to life-threatening opportunistic infections. This means that patients are often admitted here, get very sick soon after, and have to be discharged from PSI only to be re-admitted days later after their hospital stay. This procedure saves Medicaid money since they are not paying for two beds simultaneously (one at PSI and one at the hospital), but it is a huge hassle for the patients and staff here.

Last week, more budget cuts led to additional restrictions on when patients can leave PSI and still be covered by Medicaid. Patients who have been here for a while are given privileges such as leaving the facility to visit loved ones. Medicaid used to cover 18 of these visit days per year, but recent changes has limited it to 10 days. Any more time that patients spend visiting family and friends is paid out-of-pocket by PSI. Additionally, recent regulations have limited the total number of hospital days that Medicaid will pay for to 14 days per year. For patients as sick as ours, this is quite unrealistic, and PSI will likely end up paying the extra $400 per day for patients who need to spend more time in the hospital.

The staff of PSI is still unsure of how to handle these changes. Some solutions that staff members have discussed include discharging patients any time they go to the hospital in case their stay is unexpectedly long, or decreasing the total length of the treatment program here so that patients will not exceed their allotted time out of the facility. These solutions are far from perfect. Unfortunately, all of these restrictions imposed on PSI by the government are not in the patients' best interest - what should be Medicaid's top priority.

2 comments:

  1. I do not understand the logic behind not Medicade not paying for a nursing home patient's cost of living if they are admitted to a hospital within the first 30 days. Is that because the nursing home is still charging Medicade when they are in the hospital? I have another question, if an individual is discharged and subsequently admitted to a hospital, can they be readmitted to PSI and have Medicade pay for the bill?

    ReplyDelete
  2. Chris, yes the nursing home would still be charging Medicaid for the bed. And yes, patients can be readmitted to PSI and have Medicaid pay. Many patients there now are on their second or third stay there.

    ReplyDelete