Winston Sherman and his wife, Barbara, waited nearly a year… (Baltimore Sun photo by Jed…)
A growing backlog of requests for state medical assistance has Maryland's nursing homes picking up the tab for millions of dollars and patients facing months of uncertainty over the status of their claims.
In one case, an Ellicott City nursing home did not receive a payment for a 59-year-old patient with debilitating multiple sclerosis for about a year, between December 2008 and last month.
During that time, the patient, Barbara Sherman, her husband, Winston, and their elder-care lawyer repeatedly called and wrote the state Department of Human Resources. Her annual Medicaid recertification was denied Oct. 13, but was approved without explanation a few weeks later after inquiries from a Baltimore Sun reporter. A check for $80,000 followed.
"I'm satisfied," Mr. Sherman said about the payment. "My concern is you shouldn't have to go through this."
Such lengthy ordeals are increasingly common. After years of job cuts because of budget cutbacks, the state is struggling to process sharply higher numbers of requests for all kinds of aid, said officials at the Department of Human Resources, which processes the applications.
Brenda Donald, secretary of human resources, recently authorized $77,000 in overtime to ease the 1,200-case backlog of Medicaid reimbursement requests for nursing home care, department spokeswoman Brenda Tolson said in an e-mail. The department also opened a regional office in Catonsville to speed payments in four of the state's large jurisdictions. Tolson said overtime work began in November, and the backlog should be eliminated in four to six months.
The state is supposed to rule on applications for assistance within 30 days. The backlog for a different kind of aid - food stamps - prompted a lawsuit that was decided against the state Thursday. A Baltimore judge ordered DHR to comply with the 30-day rule on food stamps and medical benefits. Nursing home can't file such lawsuits, because the payments aren't made to them, and Tolson said the court decision doesn't specifically cover those payments, though she agreed that state rules require eligibility applications to be processed within a month.
Meanwhile, nursing homes say they have had to absorb the costs of caring for patients. The costs can be substantial: Maryland's 218 nursing homes get about $1 billion in state Medicaid payments annually, state officials said.
"Unfortunately, it's not unusual in the state of Maryland," said Dean Smith, administrator at the Ellicott City Health and Rehabilitation Center, where Barbara Sherman has lived since last December, after spending two years in other homes.
Because of state delays, Smith said, his facility is carrying the roughly $6,000-a-month cost for more than two dozen patients. About 60 percent of his 182 patients are on Medicaid, he said. If his facility weren't part of a larger corporate chain, "we'd go out of business," Smith said.
Maryland law makes it difficult to evict patients, so the homes typically carry the costs until payment is approved, industry officials said.
Danna Kauffman, a senior vice president for Life Span Network, a trade group that represents 100 mostly nonprofit nursing homes, said the state often takes six to nine months to approve payment, and things have become worse. "If something doesn't let up, we're going to see places going out of business," Kauffman said.
The delays can mean a large home is carrying up to $1 million in unpaid costs at any given time, which could affect staffing and patient services.
Susan M. O'Brien, vice president of public affairs for the Health Facilities Association of Maryland, the for-profit trade group for more than 150 homes, said the economy is another factor. Nursing homes awaiting long-overdue payments are having a tough time making their monthly budgets.
"Everything's been made worse by budget cuts," she said. "For smaller homes, it's certainly a huge issue."
Requests for all kinds of help increased 33 percent between January 2007 and September of this year, state officials said. Since 2002, total caseload has jumped over 50 percent with 277,000 additional cases, while staff shrank by 23 percent, or 550 positions.
"We don't have enough staff" to handle all the requests coming in," said Stacy Rodgers, deputy human resources secretary.
Rodgers said the state created a new "stuck cases" review process in March that has handled 419 delayed cases cited by nursing homes, clearing 188. Also, a new regional office for longterm-care certifications opened in Catonsville this fall, the result of a unanimously approved 2008 General Assembly bill urging faster action and less red tape. The office has 20 workers handling cases from Baltimore City and Anne Arundel, Baltimore and Prince George's counties, which have the largest number of cases, Rodgers said.
Another new program for short-term nursing home stays has processed 3,000 transactions, officials said. Rodgers said nursing home industry representatives have been working on the problem with the state for more than a year.
The recent approval of Barbara Sherman's Medicaid payments for another year brings a welcome resolution to months of frustrating silence from the state bureaucracy. "It just goes into a black hole," Winston Sherman said of his unanswered requests for information.
On top of worrying about his wife's medical condition, he had to endure the strain over the uncertainty of payments, he said - and with an aging population, many more may face the same worries. "You had better care," Sherman said, "because you may be in the position I'm in, in a few years."