WASHINGTON, DC — Amid talk of major Medicaid cuts and the possible dismantling of outdated healthcare funding mechanisms, skilled nursing providers meeting in the nation’s capital this week have a rare, well-timed opportunity to remind lawmakers about the critical care federal programs fund.

That was the inspirational takeaway first-year American Health Care Association President and CEO Clif Porter delivered Monday as he rallied his troops to call on their own “grit” and “stick-to-it-tiveness” to help protect Medicaid and Medicare and press Congress to provide regulatory relief.

Now that the federal nursing home staffing mandate appears all-but-resolved, Medicaid cuts are squarely in focus at the annual two-day Congressional Briefing, which includes a record 700-plus members taking to Capitol Hill for planned visits Tuesday.

In conjunction with the event’s opening, AHCA released the results of a new survey that found that an “overwhelming majority” — 79% — of nursing home providers are “extremely concerned” about potential Medicaid reductions. Another 13% of 363 nursing home leaders surveyed last month said they were “moderately concerned.”

A 10-year House budget reconciliation bill narrows Medicaid coverage eligibility, freezes provider tax rates and shortens the window of retroactive Medicaid payments to 30 days. This is among billions in other safety-net spending cuts. The reconciliation package is now in the hands of the Senate, which appears less ready to pass massive Medicaid cuts but is openly toying with Medicare changes.

“They absolutely need to hear from you and they need to understand exactly what the impact is of Medicaid cuts on your facilities,” Porter told his members. “When we talk about these hard, arcane policies that are out there, like provider taxes, it has real consequences on the operations. … You’ve got to tell that story. You’re got to translate that in real teams for them on Main Street, in their district.”

Medicaid is the number one payer for US nursing home care, but two-thirds of AHCA’s survey respondents said the program covers less than 80% of the actual costs of care. Another 11% said they’re receiving even less — under 50% of their costs of care.

The survey revealed 55% of providers would have to reduce their Medicaid census amid cuts, with 27% reporting they’d be forced to close.

That makes any Medicaid reduction “a non-starter,” Porter said.

“Medicaid must provide the proper resources to states to care for residents. Right now, we are underfunded. We get 82 cents on the dollar. That’s with provider taxes. If you cut provider taxes, that number goes down further,” he added. “We shouldn’t be talking about numbers going down further. We should be talking about how we can further fund the system so that we can do a better job of caring for folks.”

The association is also pressing forward on efforts to bolster nursing home hiring, with more than 48,000 workers still needed to meet pre-COVID levels by the end of April.

The sector picked up another 6,000 workers in May, but the pace won’t prepare for the shifting demographics. Porter highlighted the coming increase in 80 year-olds and older Americans — adding four million over the next five years, and another four million over the next five — and the 20% of those seniors who will need the services of a nursing home. 

By 2065, nursing homes are expected to care for twice as many residents as they do now, despite the threats to funding dominating Congress in the current session.

Medicare Advantage challenges and tough questions about whether privatization has delivered on the promise that was made to beneficiaries also need addressing, Porter said. He noted that lawmakers on both sides of the aisle are open to hearing about MA, its shortcomings and possible improvements.

Also needed, according to AHCA’s Better Way strategic plan, is a smarter approach to regulation.

“This is not about reform. This is not about repeal,” Porter said Monday. “This is about making a system that does not work for patients, that does not work for providers — it works for no one — and we have to create a system and think differently about how we’re regulated and more importantly, create a system that actually improves care and actually supports providers that actually have the goal of improving care. It’s not just about penalizing providers.”

Porter said the timing was “providential” given the budget decisions being made in the Senate over the next several weeks and that he was “super excited about our prospects for success.”

One seeming ally in DC is Sen. Chris Van Hollen (D-MD), who used a video message praising Joe Warner Patient Advocacy Award winner Joe DeMattos to criticize the House reconciliation plan as a “five-alarm fire for our older family members and loved ones with disabilities who rely on long-term care services and supports.”

“For so many Americans,” Van Hollen said, “Medicaid is the difference maker that protects people’s health and keeps people out of poverty.”