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Harrington Meyer investigates how Medicaid reimbursement rules affect nursing home admissions
A few years ago, when Madonna Harrington Meyer lived and taught in Illinois, that state froze the rate of Medicaid reimbursements for nursing home care. The private-payment rates for nursing home continued to rise, though. The result, Harrington Meyer discovered, was systematic discrimination against Medicaid patients. Many nursing homes kept separate waiting lists for Medicaid and private-pay patients, admitting the private payers much faster than the Medicaid patients. Many also put a cap on the number of Medicaid patients they would admit. Minnesota and North Dakota have tried to derail such discrimination by passing a law that mandates equal rates for Medicaid patients and private payers in nursing homes. Harrington Meyer, now associate professor of sociology in the Maxwell School, director of SU’s Gerontology Center and senior research associate in Maxwell’s Center for Policy Research, recently was awarded a $99,533 grant from the Robert Wood Johnson Foundation to find out whether this solution is effective, and whether it could reasonably be applied in all 50 states. “People who are opposed say that an equalization law will cause nursing homes to close, or to reduce the number of certified Medicaid beds,” Harrington Meyer says. “We’ll investigate what happens in states where the rates are controlled. Have nursing homes closed? Have they moved to other states that have no such controls exist?”The study will also look into how such equalization laws affect the Medicaid budget and the effect on families of such rules. Harrington Meyer will talk to officials in all 50 states about what their Medicaid reimbursement rate rules are. As far as she knows, only Minnesota and North Dakota have rate-equity laws, but other states have rules to limit the disparity between what Medicaid pays and what private patients pay. New York has no such rules, and the private-payer rates are substantially higher than the Medicaid reimbursement rates.In addition to discriminating against the poor, nursing homes that admit Medicaid patients at a lower rate also, in effect, discriminate against women and ethnic minorities, Harrington Meyer points out. That is because elderly women are more likely than elderly men to be on Medicaid and to become nursing home patients. Blacks and Hispanics are not more likely than whites to go to nursing homes, but when they do, they are more likely to be on Medicaid. Harrington Meyer originally looked into whether Medicaid patients received a lower level of care in nursing homes, as compared with private payers. She did not find that to be true, but she was “quite stunned” by the amount of discrimination that takes place at the point of admission. In addition to keeping two waiting lists or putting a cap on Medicaid admissions, she found that nursing homes sometimes discriminate by requiring a three- to six-month deposit from Medicaid patients. Harrington Meyer has been interested in long-term care and its effects on individuals and families since she was an undergraduate in sociology and urban studies at Hamline University in St. Paul, Minn. Her interested continued through her master’s work at the University of Minnesota and her doctoral work at Florida State University. She is the editor of “Care Work: Gender, Labor, and the Welfare State,” which was published by Routledge Press in 2000.