Connecticut owes its nursing homes $55 million in unexpected Medicaid reimbursements after enforcing staffing requirements beyond what were laid out in its 2021 staffing mandate. The state’s Department of Social Services reported the figure to the Legislature last week — it was at least 55 times larger than what had been budgeted for the year. 

The staffing mandate set a minimum of 3.0 hours of care per resident per day. It did not, however, specify what types of care workers were required to take part in meeting that 3.0 hour minimum. 

In contrast, Connecticut Department of Public Health Commissioner Manisha Juthani required nursing homes to provide at least 0.84 hours of care per day specifically from registered nurses. 

This additional requirement remained in effect from March 2023 through January 2024, which caused increased staffing costs for the state’s nursing homes, according to Matthew Barrett, president and CEO of the Connecticut Association of Health Care Facilities.

“Because the now former DPH rule had the force and effect of law from March 2024 to January 2024,” he told McKnight’s Tuesday, “many nursing homes increased staffing to comply with the rule and incurred increased costs. During this period of time, nursing homes received enforcement violations and had to implement corrective action plans to comply with the rule that has now been withdrawn.

Spotlight on RNs

Connecticut’s 3.0 hour minimum matches the total of a federal staffing mandate proposed by the Centers for Medicare & Medicaid Services in September. The additional stipulation of 0.84 hours of RN care is echoed by a smaller requirement of 0.55 hours of RN care proposed by the federal regulator. 

Already adjusting to the new staffing mandate and to heightened oversight from the state government in general, CAHCF sued over the RN hours requirements in October while they were still in effect. The provider association, representing 165 nursing homes, has not yet withdrawn the legal action, according to Barrett.

Most Connecticut facilities could already match the 3.0 hour mark set by the Legislature in 2021. The estimated price for the government to bring the rest of the state up to that level was $1 million or less. 

In November, the Legislature received a third-party analysis suggesting that the DPH’s RN rules would cost the state at least $40 million. Weeks later, the policy was discontinued. 

State officials believe some of the already-accrued cost can be covered by CMS, but the state will likely be left on the hook for half of the unexpected funding. With more than 230 licensed nursing homes in the state, facilities may be looking at as much as six figure reimbursements for the former RN requirements. 

Barrett confirmed that reimbursements are legally required to be distributed in a “reasonable period of time,” but that no clear timeline has yet emerged.