EDITORIAL: LePage is three months late to nursing home funding fix

July 18--Amid Gov. Paul LePage's dizzying politicking in recent days, it's a wonder Maine's nursing homes actually will see a bump in their reimbursements this fiscal year that nearly equals the amount by which the state underpays them.

After challenging Democratic legislative leaders off and on for months to call the 186-member Legislature back to Augusta to address a nursing home funding shortage, LePage said Thursday his administration has found $4.6 million in state savings it can devote to nursing homes. No Legislature needed.

LePage clearly wants it to appear as if he has risen above partisan squabbling by politicians in the Legislature, acted as the adult in the room and solved the problem that has caused two nursing homes recently to announce they're shutting down. But LePage's actions this year don't bear out that image. His behavior is puzzling at best, dishonest at worst.

During a news conference Thursday to announce the $4.6 million funds infusion for nursing homes (which, he says, the federal government will match with $8.5 million), he castigated Democratic lawmakers for solely "giving lip service" to the issue.

"We are taking action, and the Legislature isn't part of this solution," LePage said, according to The Associated Press. "They are part of the problem."

Just months ago, the exact opposite was true. Lawmakers from both parties made significant headway this past legislative session in shoring up nursing home finances -- and they did so without any help from the Republican governor.

LePage's newly discovered $4.6 million in savings isn't the only funding bump Maine's nursing homes will see this state fiscal year, which began July 1. That money comes on top of another $4 million increase the Legislature set aside earlier this year for nursing homes -- which will work out to $12.3 million with federal matching funds. That money came from a pool of funds the state expects to recover from assisted living facilities it has overpaid because of a faulty claims system.

The Legislature earmarked that $4 million increase in a bill LePage refused to endorse with his signature.

That bill also contained a solution to the problem at the root of Maine nursing homes' perpetual underpayment by Medicaid, which amounted to $29.4 million in 2011. That solution is to require the state to reset nursing homes' Medicaid rates every two years to reflect their more recent costs.

Since Maine law has not had a periodic reset requirement, it has been easy for policymakers to continuously put off rate changes. As a result, nursing homes are currently paid based on their audited costs from 2005. They've been paid at those rates since 2008, save for a 1.5 percent raise in 2012.

The rate reset requirement should prove a key structural reform in the way nursing homes are paid by Medicaid, and LePage will have had nothing to do with making it happen.

The other improvement for nursing homes for which the Legislature can take credit and LePage can't? A $13 million funding increase for nursing homes in each of the next two state fiscal years, which start July 1, 2015, and July 1, 2016.

That funding increase was part of a supplemental budget package that passed the Legislature with overwhelming support. LePage sat out the budget process, so he had nothing to do with developing the budget, and he vetoed the final product.

The current Legislature has no power to set the state budget for the next two years, but its actions make the added nursing home funds part of the baseline that's traditionally used as a starting point for state budgets.

LePage claims he's the solutions-oriented adult in the room. But it's hard to arrive at that conclusion after an honest analysis of the facts.

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