Complete Story
10/12/2023
Payment Increases to Erode PACE Margins
Numerous updates to Medicaid payment rates have been announced in recent weeks, including increases to the Assisted Living Waiver, home health, home- and community-based waivers and private duty nursing, in addition to a significant increase to nursing facility care in July and other non-institutional care like dental services. Medicaid rate increases ranged from smaller increases (12% for certain transportation services) to major increases (nearly 80% for assisted living).
One unanticipated effect of the increases is the downstream impact on Ohio’s provider of the Program for All-inclusive Care for the Elderly (PACE), a program poised to grow in Ohio in the near future. PACE rates, like those for managed care programs, typically hover around 3 percent. Relative to the PACE expansion, the Administration is in a “quiet period” during which the applications for new PACE programs are being evaluated. To preserve the integrity of the evaluation, they have declined to discuss any aspect of the PACE program with LeadingAge Ohio and other advocates.
LeadingAge Ohio will continue to advocate for timely addressing of Ohio’s PACE reimbursement, so that Ohio does not undercut the program even as it attempts to expand it. While nursing facility reimbursement increased effective July 1, other HCBS payment rates will take effect January 1, 2024. The PACE awards are required to be announced by February, but LeadingAge Ohio is hopeful we may yet hear the announcements this autumn.
Questions regarding this issue may be directed to Susan Wallace at swallace@leadingageohio.org.