WASHINGTON -- The Bush administration has ordered more than 100 investigators to California to inspect nursing homes after federal officials said the state had openly defied a federal law setting more stringent standards for long-term care of the elderly.
Gail R. Wilensky, head of the federal Health Care Financing Administration, said yesterday that she was sending the inspectors to California because state officials "chose not to follow the federal procedures that all other states are following" for the inspection of nursing homes.
In a letter to President Bush last month, Gov. Pete Wilson said that the federal government was "improperly attempting to mandate standards on the states," and he asserted that the rights of nursing-home residents in California were adequately protected by state regulations.
The dispute has caused an extraordinary showdown between two Republican administrations in Washington and Sacramento. It illustrates the anger and frustration of state officials who assert that Medicaid costs are soaring because of federal laws and regulations governing the health program for low-income people.
While states are often sluggish in following federal laws, it is unusual for them to challenge a federal enforcement regime so openly, as California has done.
As a result of the action Wednesday, 111 of the 139 federal inspectors will be stationed in California. Eight or nine are normally assigned to the state.
Although initially apprehensive, most states are now trying to carry out the new federal standards for nursing homes.
Only a few states have been cited for problems.
But Dr. Kenneth W. Kizer, director of the California Department of Health Services, described the federal action as "strange and bizarre."
"The federal government made no meaningful effort to explain it to us," he said.
California officials say that compliance with the federal requirements would cost the state Medicaid program $500 million a year and that the state would have to pay half the cost.
A confidential analysis written by state health and budget officials says, "We do not consider that there are improvements in care which justify the increased cost."
California has 1,150 nursing homes with a total of 102,000 residents, including 72,000 on Medicaid or Medicare.
The California Medicaid program spends $2 billion a year on nursing home care. Half the money is federal; half is state.