James M. Berklan

It seems nothing comes easy in long-term care. Regulatory change is a constant threat, more restrictive legislation is always in the works, and finding qualified workers is invariably a challenge. And funding? Well, let’s just say it’s constantly in peril. 

Therefore, the fact a national Medicaid brouhaha is unfolding Thursday morning should not surprise anyone. It should, however, scare the daylights out of providers.

This promises to be a cage match like no other, and it has providers’ No. 1 funding source in the center of the soon-to-be-bloodied ring. The good news is, senior care providers have plenty of company on their side, just like last time.

That was in the Trump administration’s first year. I recall vividly how long-term care lobbyists, personal interests not withstanding,  were near giddy at the prospect of having Republicans in control of both chambers of Congress and the White House. The implication was that regulatory and funding heat traditionally is much lower without Democrats pulling too many levers.

And then the sucker punch came with the administration announcing it would push to allow states the option of block grants for their Medicaid systems. A block grant by any other name is a cap on spending, which could lead to cutbacks in services and numbers of people served.

The administration is expected to unveil its second big drive for Medicaid block grants Thursday. Providers’ scars have not healed yet from the first time the Trump administration tried to wedge them into the process. 

This time, they face a wiser, more experienced opponent on the issues. Why else would the administration re-introduce such a controversial subject if it hadn’t learned from the first bloody-knuckle fight over it? Could there be something more palatable coming this time?

Details of the plan had been widely leaked by Wednesday, but finer points of what is being proposed — including possible ramifications for long-term care operators — weren’t known. Some vulnerable populations, such as the disabled, are expected to be exempted from parts of the new policy, which is aimed at curbing spending in the aftermath of expanded Medicaid rolls in recent years.

That said, the block-grant issue is going to unleash all kinds of brawls in the legal system, on the airwaves and in the court of public opinion. Changing this institution in such a big way would affect everyone touched by it, and right now that’s 1 in 5 Americans.

Battle lines are clear in some instances, but are not a universal concept. Although block grants are largely opposed by Democrats and supported by Republicans, there are governors from both parties on each side of the equation and even conservatives wonder if any block grant can pass legal muster. 

Legal challenges are sure to be mounted and already there are doubts that anything new could be enacted for at least a year, anyway, if not much longer.

Nonetheless, a pall exists. There are also worries that the massive provider coalition won’t be strong enough to turn this one back as it helped do before. This is not going to be a normal funding fight.

I can tell you I’ve heard countless dour forecasts and seen many worried faces among nursing home advocates through the years, but I don’t think I’ve ever seen the depth of panic as I witnessed the last time this was in the headlines.

Bundle up and start looking for allies. This one is not going to be short, and it’s not going to be easy.

Follow Executive Editor James M. Berklan @JimBerklan.