Will CT mandate for nursing home staff cost $380,000 per year or $40 million? Committee unsure

CT Insider – Friday, December 20, 2024
By Ken Dixon

HARTFORD — Amid a major discrepancy over what a proposed regulation on nursing home staffing might cost at a time when the state’s federally supported Medicaid budget is already $250 million in the red, a bipartisan legislative committee has at least temporarily rejected the proposal pending further information and discussions on the agency staff level.

While lawmakers said this week that some nonpartisan analysts pegged the potential cost of requiring more certified nurses aides and social workers at $40 million, officials from the state Department of Social Services and the state Department of Public Health said the cost would be about $380,000 per year among the 197 state-supported nursing homes.

That disagreement prompted the Regulation Review Committee, the only General Assembly panel with both Republican and Democratic co-chairs, to postpone action until after the next legislative session starts on Jan. 8.

“I’m having a hard time getting my mind wrapped around this,” said veteran Sen. John Kissel, R-Enfield, the co-chairman, warning that the higher estimate of costs could become a major financial headache for the DSS at a time when fellow committee members including Sen. Cathy Osten, D-Sprague, the co-chairwoman of the budget-writing Appropriations Committee, warned that overall Medicaid support under the incoming Republican administration in Washington is uncertain.

“There was a concern raised regarding the fiscal impact,” Kissel said. “The department is actually on the hook for paying for the additional staffing if they’re required to fulfill the ratio requirements in this regulation. That’s a substantial amount of money and that would have to be paid by the Department of Social Services. I don’t think that we should allow regulations to go through unless their total impact is addressed at this stage.”

State Rep. Lucy Dathan, D-New Canaan, the committee co-chairwoman, stressed that lawmakers are worried that the $380,000 agency estimate might not include the potential for major Medicaid exposure. “We need to understand if DSS is going to be paying the increased Medicaid costs,” she said. Nicole Godburn, fiscal manager for the DSS, which is the primary payer for nursing homes, told the committee that federal support is 70 percent of nursing home costs and that currently, four nursing homes would not meet the staffing level requirements for social workers and two dozen would fall short in higher levels of certified nurses aides.

“To me, if nursing homes have to hire new people, there are substantial costs with that even if there’s federal reimbursement of 70 percent,” Kissel said. “Most nursing homes are currently meeting this particular standard,” Godburn replied.

Kissel said he respected the agency’s estimates. “It’s surprising to me because the way this was described to me several months ago when it first came up was that the impact to the DSS side would be in the millions of dollars and now it’s far different than that.”

Dathan calculated that the average pay to make the $380,000 estimate would be a near minimum-wage level of $16,780 per person, to which Godburn replied that some of the workers would be part-time. There are about 70 nursing homes with unionized workers. Statewide, there are about 15 nursing homes that are privately supported by residents and their families, do not take Medicaid residents and generally pay their staffs more money.

“I certainly believe in the staffing ratios,” Osten said. “But I want to make sure that we’re going to pay the nursing homes what they deserve to be paid. My concern is that we are making it impossible for nursing homes that are on the lower-performing sides of things to get reimbursed at a rate that will allow them to become a higher-performing nursing home.” In particular, Osten said she was concerned about lower-income residents in facilities that pay employees less. “Are we going to say that private-pay people deserve better care?”

While the regulation started out on track to be approved, the sentiment of the panel shifted during the half-hour discussion attended by committee members both remotely and in the Legislative Office meeting room.

“This is a law that should be looked at by the whole legislature,” added state Rep. Craig Fishbein, R-Wallingford, stressing the unique character of the committee. “The numbers started on this, we originally heard millions and now we’re down to a fraction of that. I support the staffing ratios. You would have thought that this would have been done voluntarily by the industry. At the end of the day, the nursing home is not getting 100 percent reimbursement then you’re going to have nursing homes going out of business. That is the last thing that I want to be blamed for: this very small committee of the entire legislature. The impact really should be dealt with by the full body and I see no reason why it can’t, actually.”

Veteran state Rep. Bob Godfrey, D-Danbury, then withdrew his motion to approve the regulation. It was then rejected without prejudice and is expected to be reintroduced next year.

State law requires the Department of Public Health to create minimum staffing level requirements for nursing homes of three hours of direct care per resident per day and to change staffing levels for social workers to have a full-time social worker per 60 residents.

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