For revenue cycle consultants in New England, the September 5th headline in McKnight's Long-Term Care News begs clicking to learn more, MassHealth found to be in violation of federal regulations.
The article describes a June 2018 Suffolk County Superior Court ruling against Mass Health for "violation of federal Medicaid regulations by issuing “standardized” eligibility denial notices in long-term care coverage cases for excess countable assets held in a trust." Seems pretty esoteric but the impact on SNF/Nursing Home residents as described in he article, as well as on the facilities caring for the residents, appears significant. The generic notices left the elder and their family (if they have family that is involved) without specific information to track down support to refute the determination and the facilities are left without reimbursement because the law prohibits discharging the resident for non-payment.
Increasingly, individuals and advocacy groups refer to healthcare as a right. Our laws implicitly support this view to the extent healthcare providers and hospitals accepting Medicare or Medicaid must provide emergency care without regard to ability to pay, cannot balance bill patients covered by government programs, and in states like Massachusetts, cannot evict a long-term care facility resident for lack of ability to pay in situations detailed in the McKnight's article. Healthcare delivery has also evolved into a big business. Arguably, a business unlike any other due to the aforementioned laws and more.
As the silver wave crests and the ranks of the 'oldest old' swell, long-term care demand may outstrip supply, we'll need to collectively address the question the article begs, is long-term care a right?