A Maryland nursing home was set to evict an 82-year-old woman after the woman's daughter, dying of bone cancer, could no longer pay the high private-patient rates. Another Maryland facility talked a 76-year-old woman into mortgaging her paid-off home to meet $18,000 a year in private-patient costs for her husband.
And a third patient's family could not escape a nursing home's grasp even after the patient died. The home dunned the family for a full year's worth of payments under a contract the family had signed, although the patient died after three months in the home.
In all three cases the patients were eligible for Medicaid, but the nursing homes refused to accept the lower rates Medicaid pays for patient care, according to Maryland Attorney General Stephen H. Sachs, who is fighting to stop such practices.
Sachs, in testimony at a hearing yesterday before the Senate Committee on Aging, underscored what Sen. John Heinz (R-Pa.) said is a nationwide problem -- discrimination by nursing homes against elderly Medicaid patients in "flagrant violation of the law."
Heinz said his committee is investigating ways to give the states "a bigger stick" for enforcing a 1977 federal law that prohibits nursing homes from charging extra money for admitting or keeping a Medicaid patient.
In Maryland, Sachs' office is seeking sanctions against 22 local nursing homes.
Sachs, an announced candidate for governor in 1986, said the homes have violated the law by requiring patients to contract to pay higher private-patient fees for a year, even if they become eligible for lower Medicaid rates during that period.
Maryland's top health official, the secretary of Health and Mental Hygiene, ordered the homes to stop the longtime practice, and most of the state's 200 nursing homes complied more than two years ago. But 22 homes are appealing the ruling in a case that is to be heard before an administrative review board Thursday, according to assistant attorney general Jennifer Robbins.
An official in the D.C. Department of Human Services said there is no similar problem in the District, where more than 95 percent of the patients in facilities certified to receive Medicaid are on that program.
In Virginia, a Medicaid official said there may be "isolated incidents," but "we've not had difficulty with providers on a wholesale basis playing these games."
Sachs told the Heinz committee that some nursing homes in effect tell prospective patients: "You may come into this home only if you will pay me at the higher private pay rate for one year, whether or not you become eligible for Medicaid during that year."
Medicaid rates in Maryland nursing homes are between $1,300 and $1,600 a month, depending on the level of care -- about $400 a month lower than private-patient rates, according to Sachs' office.
Maryland facilities involved in the appeal contend that the federal law prohibiting homes to charge extra applies only to persons admitted as Medicaid patients and not to those determined later to be eligible.
Sachs and other officials disagree.
Paul Willging of the American Health Care Association, which represents about 8,600 facilities, said after the hearing that the problem stems from state-mandated limits on the number of nursing home beds available and low Medicaid reimbursement rates set by some states, although he said this does not apply in Maryland. "You do have a market where the operator has to go for private-pay patients as the only way to keep the doors open," he said.