A change in the way the state reimburses the DuPage Convalescent Center for providing care to Medicaid patients could force the county to contribute more money to keep the Wheaton facility open.
DuPage County already contributes $2.4 million for the nursing home that often is the only option for indigent residents in need of 24-hour nursing care.
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Another $15.4 million of the center's roughly $35 million operating budget comes from Medicaid payments. About 80 percent of the facility's 360 patients are insured by Medicaid, officials said.
But during a Tuesday presentation by one of the governor's top aides, county board members learned that as much as $2.69 million of the center's Medicaid payments could be lost.
"It seems like every time we think we have a good system set up for funding the convalescent center, the rules of the game change," said county board member Robert Larsen, chairman of the board's health and human services committee.
The $2.69 million is an additional payment the state has been making to the convalescent center because it's a county-operated nursing home, officials said. The so-called "enhanced payment" is above and beyond the standard payment rate.
County officials say the extra money is needed because the center's standard rate is less than the actual cost of providing care.
However, state reforms of Medicaid have restructured the reimbursement system.
"The payment structure for county nursing homes must change as well," said Cristal Thomas, deputy governor for public policy.
One consequence is the elimination of the enhanced payments, which the state paid with money it received from the federal government.
"Under a managed care structure, those kinds of supplemental payments are actually not allowed," Thomas said. "So we are in a situation where we know that will result in a loss of revenue for both the county and the state."
Still, Thomas said the state is committed to working with DuPage officials to address the situation. She said one possible solution is for the state and county to approve a new intergovernmental transfer agreement that would pay the convalescent center a higher reimbursement rate.
But when asked by Larsen if a new pact would pay the entire $2.69 million, Thomas said she couldn't promise that it would.
"It's very likely that it will cover at least the majority of the gap that's being created here," Thomas said. "I cannot commit to you that it would cover all of it."
Larsen said he hopes state officials realize any reduction in the Medicaid reimbursements would be ill-advised.
"While the state has major budgetary concerns," he said, "taking away funding for care of seniors in need and people with long-term disabilities is not the place where you want to cut the budget."
Larsen said part of the reason the convalescent center has so many Medicaid patients is because many private-pay facilities won't take them.
"We're trying to provide a safety net for the most vulnerable population out there, those who can't get into a private pay system," Larsen said. "If we now get to a point where the budget gap becomes untenable for us, then that creates a real problem for us. I don't want the mission to fall to the wayside because of the compensation issue."