When a family member becomes too ill for loved ones to care for him or her, families turn to nursing facilities to provide the day-to-day medical needs. For families applying for long-term care coverage through Medicaid, the process is complicated and often frustrating. Getting approved can take months.”It’s a nightmare for families,” said Arlene Miles, president and chief executive officer of the Colorado Health Care Association, an organization that works to improve communication between county governments and long-term health care providers.Miles said federal regulations stipulate that Medicaid applications be processed within 45 days of admission to a long-term care facility. Statewide, Miles said the average processing time is 90 days, and El Paso County is among the worst.”Nursing homes will take debt with no cash or reimbursement for a significant length of time, but they can’t continue to provide care without cash flow,” Miles said.Kay Stark, administrator at Garden of the Gods Care Center, said it is not unusual for her facility to care for a patient without Medicaid payments for up to six months. At one point, Stark said 20 percent of the center’s patients were in pending status.”It killed us on operations,” Stark said. She said they relied on support from their parent company to float them until the patients were approved and they could once again meet their operational costs.Since then, Stark said the center changed its policies and will only accept two Medicaid-pending patients per year. The facility is careful to only take patients whose applications will be cut and dry.Stark said many facilities throughout the region are taking similar measures, which leaves few beds available for some of the county’s extremely ill and impoverished residents. If families cannot pay out of pocket and cannot find a Medicaid pending opening in a long-term care facility, they will have to bring the patient home and provide care themselves or apply for Medicaid Home and Community Based Services, which provides in-home care for certain costs.”It puts a lot of stress on the family,” Stark said.Scott Bartlett, lead long-term care ombudsmen for El Paso County, said processing delays come from two sources. First, El Paso County doesn’t have the staff or the resources to meet the workload. Second, Bartlett said families have to be on top of all the paperwork, prepared with definitive sources to verify income and prove expenses.Bartlett said once a patient is Medicaid approved, the nursing facility will receive payment retroactive to the date of admission. But in the case of long delays, Bartlett said the lack of payment impacts everyone in the building.Christopher Garvin, manager of Aging and Adult Services for El Paso County, said his department is not behind in processing long-term care Medicaid applications.He said his office processes nearly 5,000 applications per year – handling applications for food stamps, aid to needy disabled, old age pensions and long-term care.”Eighty percent of our applications are timely,” Garvin said. He said of the 373 long-term care applications currently pending, only 71 exceed the federally mandated processing time.Garvin said the applications are complicated and require documentation and verification of income and financial assets. Nine out of 10 applications are incomplete when submitted, he said.Of the 20 percent exceeding the processing time, Garvin said half of the delays can be traced to incomplete applications. The responsibility for the other half of the delays rests on his department. “We’re short on staff,” he said.When Garvin became manager of Adult and Aging Services two years ago, there were four technicians to handle the influx of claims. He said training and building competency in the position takes nine to 12 months. His staff currently includes 11 technicians, with five employees with less than one year on the job.Boosting morale and providing training are important strategies in retaining employees. “One of the biggest complaints was technicians said they didn’t have the skills to do the work,” Garvin said. New employees now take a six-to-eight-week training course.Garvin is trying to increase efficiency in the application process and open communication lines between the county and nursing facilities. He said he holds monthly meetings for nursing facility staff to provide updates and maintain an open dialogue.”We’ve come a long way,” Garvin said. “If I could offer one piece of advice to anyone working on an application: Make sure it is complete.”
