March 2023

Founder’s Message

How do we make the Medicaid message stick?

Repetition is associated with comprehension and memory at all levels. As children, we heard our parents constantly repeat warnings, “Look both ways before…..” and coach us on manners, “Say please and thank you” and give us positive reinforcement, “Well done!” and negative reinforcement, “Don’t touch!”

As we age, we might need to read something twice to fully retain all the information or give ourselves trigger association words to remind us or notations in our schedule or smartphone. If we want to recite a poem or sing along with a song, we will have to commit it to memory and that requires repetition.

There are only three ways that information can move from short-term memory to long term memory: urgency, repetition, or association. So sometimes we may tire of our own voice saying the same thing repeatedly, or our own thoughts going around and around on a brain reel – but when it comes to urgency, we have to believe our repetition is not falling on deaf ears. So we forge on and send the urgent message – in this case, to our Texas state legislators.

In 2021, the last time the state legislature convened, I asked Focused Care team members to write a letter to your legislators regarding the state Medicaid rate for nursing home care – one of the lowest in the nation. I made available this link (https://capitol.texas.gov/) and encouraged you to find your state representative and senator by viewing the bottom of the righthand column and inputting your address and zip code. Doing so will lead you to the website pages for your elected officials.  I’m asking you to please do this again.

All of us understand that our long term care communities rely heavily on Medicaid revenue – nearly 70% of our residents are Medicaid beneficiaries. Medicaid – as most of us know – is usually the biggest part of any state’s budget – that’s Medicaid for ALL qualified beneficiaries – not just those who receive skilled nursing care. It is also a federal program managed by a federal agency.

Medicaid reimbursement in Texas for skilled nursing care does not cover the actual cost of care per patient per day. Here are some indisputable facts:

• Skilled nursing communities lose millions of dollars annually providing compassionate, patient-centered care for Medicaid beneficiaries
• Skilled nursing communities face cost increases in both labor and operations
• By 2030, about 6.7 million Texans will be age 60 or older. Nearly 1 million Texans will be age 85 or older
• Long term care did not benefit from federal COVID funds to the extent other providers were able to participate
• The problem is not going to get better and increased volume won’t help
• The need for skilled nursing care will continue

It might strike all of us as surprising that given everything we and those we care for endured over the last few years – we have to ask for the adequate amount of funding to actually cover the cost of caring for the state’s most vulnerable. But we do.

We must repeat ourselves until the message sticks.

Mark McKenzie

Founder & CEO