Hundreds of indigent and ailing old people in Washington are neglected because the city's Medicaid reimbursements are too low to pay for their admission to private nursing homes, according to a suit filed this week against the Department of Human Resources.
The suit, filed in U.S. District Court here, charges that DHR failed by last July 1 to raise, the maximum fee of $20 a day ($600 a month) that is paid to private nursing homes for each Medicaid patient, as Congress mandated.
The payments are less than the amount it costs private homes to maintain their patients, estimated at $630 to $1,200 a month, the suit states. As a result, eight of the city's 15 licensed nursing homes have stopped accepting Medicaid patients, the suit said.
"Simply stated, the current reimbursements rates are too low and, as a direct result, (private) nursing home care has become unavailable to the poor of the city." the complaint charges. The city's only public nursing hime, D.C. Village, is short staffed and has also stopped accepting patients.
Filed as a class action by lawyers with Legal Counsel for the Elderly, a government-funded legal aid program, the suit also charges that Health, Education and Welfare secretary David Mathews illegally allowed states and the District of Columbia and 18-month extension on the July deadline set by Congress for making Medicaid payments "cost-related."
Marie cookman, 83, the named plaintiff in the suit, lives alone and is too weak to bathe, dress or cook for herself, according to the suit. She suffers from arthritis and circulatory problems that make her dependent on a mechanical walker.
Mrs. Cookman has been hospitalized several times with injuries suffered in falls, but can not dial a telephone to call for help, the suit said.
She has been trying to get into a nursing home for four months, but was denied admission to all those receiving Medicaid patients, the suit said. One home had 26 vacancies, but placed Mrs. Cookman on a waiting list, according to the suit.
while nursing homes reserve their vacant beds for private paying patients. Mrs. Cookman and "an estimated several hundred others" are "languishing in their own homes or in the homes of relatives unable to care for them," the Legal Counsel attorneys charged.
The shortage of beds for the elderly poor is further aggravated by DHR's closing of 100 beds at D.C. Village, the city's 600-bed home for the aged, the lawsuit charged. D.C. Village, threatened with loss of Medicaid funding due to staff shortages and other deficiencies, halted admissions last November.
The suit seeks a court order to increase Medicaid payments and to have Mathews rescind his extension of the Congressional deadline. Among other charges, the suit claims that:
The District spends up to $200 a day each for elderly patients in acute care hospitals who could be discharged to nuring homes if beds were available.
DHR spends twice as much a day for each patient at D.C. Village --about $46 -- as the amount paid for Medicaid patients in private nursing homes.
The maximum monthly nursing home payment for Medicaid patients in Virginia is $950 and $750 in Maryland, compared to the District's $600 maximum.
DHR officials are aware of the inadequacy of its payments. The suit cites a memorandum from suspended DHR director Joseph P. Yeldell last June, in which he says the maximum rate of $20 should be raised to $30 a day.
The lawyers also contend that the July 1, 1976 deadline set by Congress for states to make Medicaid reimbursements "cost related" was "absolute." Matthews violated that 1972 Congressional act when he extended the time limit to January 1, 1978, the suit charged.
Medicaid, the joint federal-state program to provide medical care to the indigent, is 50 per cent federally funded in the District.