Assisted-living homes are rejecting Medicaid and evicting seniors
*Washington Post, By Christopher Rowland, April 6, 2023
Some residents who drained their nest eggs to cover private-pay rates have been evicted after turning to Medicaid to pay their bills.
A recent spate of evictions has ousted dozens of assisted-living residents in Wisconsin who depended on Medicaid to pay their bills — an increasingly common practice, according to industry representatives.
The evictions highlight the pitfalls of the U.S. long-term care system, which is showing fractures from the pandemic just as a wave of 73 million baby boomers is hitting an age where they are likely to need more day-to-day care. About 4.4 million Americans have some form of long-term care paid for by Medicaid, the state-federal health system for the poor, a patchy safety net that industry representatives say pays facilities too little.
Residents of assisted-living facilities — promoted as a homier, more appealing alternative to nursing homes — face an especially precarious situation. While federal law protects Medicaid beneficiaries in nursing homes from eviction, the law does not protect residents of assisted-living facilities, leaving them with few options when turned out. In Wisconsin, residents who entered facilities on Medicaid, as well as those who drained their private savings after moving in and subsequently enrolled in Medicaid, have been affected.
“It’s a good illustration of how Medicaid assisted-living public policy is still in its Wild West phase, with providers doing what they choose in many cases, even though it’s unfair to consumers,” said Eric Carlson, a lawyer and director of long-term services and support advocacy at the nonprofit group Justice in Aging. “You can’t just flip in and out of these relationships and treat the people as incidental damage.” The U.S. government does not monitor or regulate assisted-living facilities, and no federal data is available on the frequency of evictions. In Wisconsin, The Washington Post counted at least 50 Medicaid-related evictions since the fall based on statements by operators, as well as nonprofit and government Medicaid agencies.. .
Advocates for assisted-living residents worry that pandemic-induced economic conditions are contributing to the problem in pockets of the country. Profits in assisted-living facilities are threatened by a shortage of staff and big spikes in labor costs, inflation that is jacking up the costs of goods, and higher interest rates. Meanwhile, occupancy rates continue to lag behind pre-pandemic peaks. . .
Harbor Retirement Associates did not respond to requests for comment.
The evictions carry an especially harsh sting for residents who enter assisted-living facilities paying full rates out of pocket with the understanding that, once their nest egg has been spent down, they can remain in the facility under Medicaid. Such arrangements are common across the country and are discussed with families by marketing staff, according to elder-law attorneys and industry experts.
But facilities may have strict limits on the number of beds they designate as Medicaid-eligible, or they can back out of state Medicaid contracts completely. Such caveats may be buried in the fine print of resident agreements or are not addressed at all in the contracts, according to contract provisions in the Wisconsin cases reviewed by The Post. Families often sign such contracts in a time of stress, as they are seeking a safe place for a parent who can no longer remain in their own home.