Long-term care operators must engage states to ensure Medicaid reimbursement following ACA ruling, provider group says

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AAHSA CEO and President Larry Minnix
AAHSA CEO and President Larry Minnix
While the Supreme Court upheld the Affordable Care Act, it struck a provision that said states would lose their Medicaid funding if they don't comply with the planned expansion.

The ruling means progressive action on maximizing Medicaid reimbursement is still needed, a top long-term care advocate told McKnight's.

Larry Minnix, president and CEO of LeadingAge, told McKnight's Thursday morning that nonprofit long-term care operators are going to have to lead the way in engaging state Medicaid programs, which now have more flexibility as to whether they will allow more people onto the Medicaid rolls. The court's ruling on the Medicaid expansion is central to nursing home providers as Medicaid funds the vast majority of skilled nursing care.

“Our initial conclusion is that the fundamentals of the Affordable Care Act are going to stay intact. There will continue to be an emphasis on helping people stay out of hospitals and nursing homes, and state plans are going to take these things into consideration,” Minnix said.

The high court's 5-4 decision to preserve the Affordable Care Act also is good news for proponents of the law's CLASS Act, which was shelved by the Obama administration last fall due to concerns about financial solvency.

“The law being upheld gives CLASS a better chance. There are some intricacies to work out, but the fundamentals are still in place,” Minnix said.

While many have focused on the individual mandate being upheld, other components of the ACA impacting long-term care are accountable care organizations and the Independent Payment Advisory Board.

Additionally, the American Medical Association said in a statement of support that the law being constitutional allows 2.5 million people under age 26 to stay on their parents' health insurance policies, and that the “decision upholds funding for important research on the effectiveness of drugs and treatments and protects expanded coverage for prevention and wellness care, which has already benefited about 54 million Americans.”

Following the ruling, the American Health Care Association/National Center for Assisted Living issued a measured statement reflecting that it had supported the ACA in 2010. However, it said that Medicaid shortfalls are a large issue and expressed hope that Congress now will “shift its attention to tackling the difficult challenge of how to care for a growing elderly population in an era of declining resources.”

Bruce Chernof, M.D., president and CEO of the SCAN Foundation, a senior advocacy foundation, said that the decision is “a giant step forward” in protecting Medicare “while laying the groundwork for a better approach to care for older adults with chronic health conditions and functional needs.”