Final Budget Negotiations Commence
Today is the 85th day of the 2023 legislative session. The Legislature has just 20 days to finalize the work to pass the two-year state operating budget, and to conclude work on other policy matters under consideration this year.
I am gratified that we are going into final budget negotiations in a relatively strong position—we have worked hard to help advance the priorities we identified last year. We will continue to keep you apprised as we move forward, and we will continue to look to you to advance these priorities.
Budget Matters
There are two budget proposals currently in play as the Legislature approaches final negotiations. We appreciate that budget leaders Senator Christine Rolfes (D-23), Chair of the Ways and Means Committee, and Representative Timm Ormsby (D-3), Chair of the House Appropriations Committee, included investments in the long term care workforce by allocating funds to base Medicaid rates specifically related to labor costs. We saw base rate increases for skilled nursing, assisted living, and enhanced services facility providers in both budgets.
This week, I will be personally checking in to ensure that budget writers and legislative leaders understand our priorities and the impact of these funding proposals. At the same time, we are asking our members to continue to advocate with your legislators about the best proposal for your setting.
Here are details on the best of each budget for our members:
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ESF Funding: The House budget is the preferred proposal for enhanced services facilities (ESFs). The House plan funds a 30% rate increase while the Senate plan funds a 25% increase. The House budget also includes a requirement to establish a rate-setting methodology, with a recommendation due to the legislature in 2025. Join us in supporting the House proposal for ESF funding.
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Assisted Living Medicaid Base Rates & Specialized Dementia Care Funding: The House floor-passed budget would allocate a total investment of $162.5 million in Medicaid funding to assisted living rates compared to the Senate total of $141 million. While the Senate budget puts base rates at 80% of labor costs compared to the House level of 79%, the House budget doubles specialized dementia care funding. The House plan also requires a report to the Legislature about Medicaid utilization and access. Please share your support for the House budget proposal for assisted living.
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Skilled Nursing Facility Funding: Both the Senate and House budget proposals fund the annual rebase, but the Senate recognizes that wages are not the same today as they were two years ago and provides an inflationary adjustment to address cost growth. Importantly, the Senate also provides a stop gap to eliminate potential rate reductions moving into the 2025-27 biennium, removing some of the volatility and uncertainty about maintaining operations from one biennium to the next. We support the Senate level and methodology for base rates funding. The House budget proposal, however, contains critically important policy language related to continuity and transparency of wage equity fund allocations, and we support this important language. We support Senate funding with House language related to continuity and transparency of wage equity funding. Send a message asking for your legislators to support these priorities.
Policy Round Up
Assisted living funding work remains—we have key legislators’ attention.
While the outcome remains to be seen in the final budget proposal, I want you to know that we had great support in the work on assisted living rates in both the House and Senate last week, and we have a commitment to continue this conversation in the interim.
We particularly appreciate the work of Rep. Nicole Macri (D-43) for her work to increase funding for base Medicaid rates to match Senate funding more closely for base rates. Rep. Macri also worked with Rep. Marcus Riccelli (D-3) on funding for a rate add-on for highest census Medicaid buildings at risk of closure. Rep. Joe Schmick (R-9) made a hard push for 100% funding for labor costs, but his Appropriations Committee amendment failed. We also want to acknowledge Senator Shelly Short (R-9), who attempted to amend the Senate floor budget to secure 100% funding for labor costs. Moving labor reimbursement from 80% to 100% carries a price tag of $75 million and that proved insurmountable.
While we were successful in driving additional dollars to assisted living Medicaid funding in the House budget, we recognize that additional steps to address funding are critical and we will be working closely with our providers in the interim as we continue to raise the need for equitable funding for assisted living.
Advocates in Action
Our thanks to our own advocates: Lee Field and Jerry Tretwold with Senior Services of America worked directly with Senator Shelly Short on her budget amendment, and Zack Wester, Noble Health Care, has directly worked with Reps. Riccelli and Schmick to help them understand the need for meaningful investment in assisted living care for high Medicaid-census assisted living centers. We clearly have work to do, and our goal is to grow our impact in this budget area through targeted grassroots efforts and with thoughtful, data-driven legislative discussions in the interim.
