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  1. Nursing Home Roundup: What's Causing Nursing Home Closures; Joint Letter; Free Webinar on Phase 3 Nursing Home Regulations
  2. Health Care Sabotage News: Court Strikes Blow for Health Care; Advocacy Groups File Amicus Brief in Texas ACA Case
  3. Oral Health in Medicare: Kaiser Family Foundation Releases Issue Brief
  4. Webinar – April 10, 3:00 PM – Medicare & Health Care Hot Topics – Register Now

Join Us!

6th Annual National Voices of Medicare Summit &
Sen. Jay Rockefeller Lecture

Rep. John Lewis will deliver this year’s Sen. Jay Rockefeller Lecture

Also joining us: Sen. Jay Rockefeller; Rep. Joe Courtney; Rep. Rosa DeLauro; Judy Feder of Georgetown University; Tricia Neuman, Senior VP, Kaiser Family Foundation; Henry Claypool, Technology Policy Consultant at AAPD and Former Director of the HHS Office on Disability; Cathy Hurwit, Former Chief of Staff for Rep. Jan Schakowsky; film writer Anna Reid-JhiradBen Belton, AARP Global Partner Engagement Director; and a direct-care worker from SEIU._______________


May 9, 2019
8:30 AM – 3:30 PM


Kaiser Family Foundation
1330 G. Street, NW
Washington, DC



Nursing Home Roundup:

What's Causing Nursing Home Closures?

Many nursing homes have closed in recent months throughout the country.  The nursing home industry instinctively claims that the cause is Medicaid rates that are low,[1] too low even to cover nursing home costs (See our joint letter, below).

The New York Times’ recent article about the closure of a rural South Dakota nursing facility pointed largely to Medicaid rates as the cause.[2]  In fact, the facility was closed by Court order. The facility was one of 17 in South Dakota that New Jersey-based Skyline HealthCare had taken over from Golden Living on January 1, 2017. By May 2018, Skyline had stopped meeting payroll and paying vendors, abandoning residents in more than 120 facilities nationwide. The Court-appointed receiver in South Dakota sought and received Court approval to close two of South Dakota’s Skyline facilities, including the facility cited in The Times,[3] as have receivers of Skyline facilities in other states.

Closures are not a new phenomenon and they occur for a variety of reasons. A study published 10 years ago looked at prior research on closures and at the 1,789 nursing facilities (two percent) that closed between 1999 and 2005.[4]  The researchers identified multiple factors leading to closures and determined that facilities closed when they:

  • Were small (had relatively few beds);
  • Were part of a chain;
  • Had higher than average numbers of quality of care deficiencies;
  • Had low occupancy rates;
  • Were hospital-based;
  • Had high Medicaid occupancy and low Medicaid rates.

Closures occur today for many of the same reasons, which often occur simultaneously. A facility with an overall rating of one star may claim that its Medicaid rate is low, but so is its occupancy rate and its one-star overall rating reflects large numbers of deficiencies. Medicare may terminate Special Focus Facilities that have not improved after a period of years.

Three Maine nursing facilities closed recently.  One claimed that the state’s Medicaid rates were low and that it could not afford to pay salaries after the state increased the minimum wage.[5] A second facility, with 22 residents, cited declining occupancy rates and the increase in the minimum wage as the reasons for its closing.[6] A third Maine facility cited decreased admissions, the increased minimum wage, and an inability to recruit staff. Now, its waterfront property in Bar Harbor is slated for a new hotel.[7]

Additional factors lead to closures. Lengths of stay in nursing facilities are declining, particularly for residents in Medicare managed care plans.[8] Further, public policy has supported helping people remain in their homes. Nationwide, Medicaid now spends more on non-institutional care than on nursing home care.[9] People may choose alternative congregate living arrangements, such as assisted living.

Yes, Medicaid rates are lower than Medicare and private-pay rates. Yes, Medicaid rates may be a factor in some nursing home closures. But to claim that closures are a new issue and that Medicaid rates are the cause of closures is too simplistic – and not true.


[1] See American Health Care Association’s letter to President-Elect Trump, Dec.15, 2016,
[2] Jack Healy, “Nursing Homes Are Closing Across Rural America, Scattering Residents,” The New York Times (Mar. 4, 2019),
[3] “Receiver of 19 Skyline South Dakota Skilled Nursing Facilities Proposes Plan to Close Two Facilities,” Business Wire (Nov. 14, 2018),
[4] Nicholas G. Castle, John Engberg, Judith Lave, and Andrew Fisher, “Factors Associated with Increasing Nursing Home Closures,” Health Services Research 44(3): 1088-109 (Jul. 2009).
[5] Matthew Daigle, “West Paris nursing home plans to close in 60 days,” Press Herald (Aug. 10, 2018),
[6] A.J. Higgins, “Patten Nursing Home Is Closing, And Residents Aren’t Sure Where They Will Go,” Maine Public Radio (Aug. 2, 2018),; “Sudden closure of Patten nursing home leaves residents, staff in limbo,” WAGMTV (Aug. 2, 2018),
[7] Jackie Mundry, “Songee Rehabilitation & Living Center sold,” WCSH-TV (Feb. 25, 2019),
[8] Plante Moran, Make the mark. Skilled nursing facility/Benchmarking report (Based on 2017 data) 7,
[9] Kaiser Family Foundation, “Distribution of Fee-for-Service Medicaid Spending on Long-Term Care” (FY2017),,%22sort%22:%22asc%22%7DSee, e.g., Suzanne Adams-Ockrassa, “State shifts away from nursing homes to assisted-living care for Medicaid patients,” The Register-Guard (Dec. 22, 2018),

Joint Advocacy Organizations' Letter Regarding Nursing Home Closures

The Center for Medicare Advocacy has joined with other advocacy organizations in responding to the nursing home industry’s claim that more Medicaid reimbursements are needed to improve resident care. Our one-page statement makes it clear that before giving nursing homes more public money, greater oversight of public payments for care and stronger enforcement of the nursing home standards of care are needed.

Free Webinar – Overview of Phase 3 Nursing Home Regulations: A Look Ahead

On November 28, 2019 – three years after the revised federal nursing home rules were issued – “Phase 3” requirements will go into effect. These include a number of new requirements that nursing homes must implement, and in some cases, new systems that must be put in place. This presentation will examine the Compliance and ethics program, infection prevention, trauma-informed care, the Quality assurance and performance improvement program, training time, and more.

Center for Medicare Advocacy Senior Policy Attorney Toby S. Edelman will join Justice in Aging Directing Attorney Eric Carlson and Robyn Grant, Director of Public Policy and Advocacy at National Consumer Voice for Quality Long-Term Care as presenters.

Overview of Phase 3 Nursing Home Regulations: A Look Ahead
Apr 9, 2019, 3:00 PM
Register now at:


Health Care Sabotage News:

Court Strikes Blow for Health Care

Last week, a federal district court judge put a stop to another effort by the Administration to sabotage the Affordable Care Act (ACA). The judge’s ruling halts an attempt by the Department of Labor to expand Association Health Plans and weaken the ACA. In past Alerts, we have highlighted the dangers of these plans and how they undermine our health care.

Expanding these Association Plans would make it easier for certain small employers to offer plans that don’t have ACA coverage protections. These plans could also weaken essential health benefits for people who need coverage and care the most. Others who still rely on ACA compliant plans would likely see a spike in their premiums. As CNN rightly reports, “these policies… could destabilize Obamacare by siphoning out younger and healthier Americans….” This would raise costs over time for people who are older and rely on the protections mandated by the ACA.

We stated in comments opposing the Association Plan rule that it “…will weaken the individual and small group markets that are critical sources of coverage for people with pre-existing health conditions. The effect of the rule will be lower costs and more choices for some small employers, but, conversely, increased cost and limited choice for others.” The judge who issued the ruling called it “clearly an end-run around the ACA.”

We call it health care sabotage.

Advocacy Groups File Amicus Brief in Texas ACA Case

This week the Center for Medicare Advocacy joined AARP and Justice in Aging in filing an amicus brief in Texas v. United States, urging the Fifth Circuit Court of Appeals to reverse the trial court’s December 2018 ruling that would nullify the entire Affordable Care Act (ACA). The three organizations highlight the ACA’s critical protections for older adults and the disastrous ramifications that would ensue if the law were to be struck down. The amicus brief was filed in support of the appellant states, which are led by California. Last week, the U.S. Department of Justice announced a new, more extreme position in the case, maintaining that the entire law must be invalidated.


Oral Health in Medicare: Kaiser Family Foundation Releases Issue Brief

Oral Health in Medicare: Kaiser Family Foundation Releases Issue Brief Kaiser Family Foundation recently released an issue brief, Drilling Down on Dental Coverage and Costs for Medicare Beneficiaries that examines the state of oral health for Medicare beneficiaries, including use of dental services and out-of-pocket spending. Medicare currently does not cover routine dental care, and the majority of people with Medicare have no oral health coverage at all. This leads to high out-of-pocket costs and foregone oral health care. The issue brief also discusses the means of coverage, along with scope of coverage and costs, for those Medicare beneficiaries who have access to oral health coverage through Medicare Advantage plans, Medicaid or private plans. Some key findings from the issue brief:

  • Almost two-thirds of Medicare beneficiaries (65%), or nearly 37 million people, do not have dental coverage.
  • Almost half of all Medicare beneficiaries did not have a dental visit within the past year (49%), with higher rates among those who are black (71%) or Hispanic (65%), have low incomes (70%), and are living in rural areas (59%) (as of 2016).
  • Almost one in five Medicare beneficiaries (19%) who used dental services spent more than $1,000 out-of-pocket on dental care in 2016.
  • Older adults have high rates of untreated caries and periodontal disease, which negatively affect oral and overall health: more than 14% of older adults have untreated caries and about 2 in 3 (68%) have periodontal disease.
  • In 2016, 60% of Medicare Advantage enrollees, or about 10.2 million beneficiaries, had access to some dental coverage. The remaining 40% of all Medicare Advantage enrollees, or almost 7 million beneficiaries, did not have access to dental coverage under their plan.
  • Some Medicare Advantage plans charge an additional premium for dental benefits, and enrollees must pay that premium in order to receive the dental coverage. Overall, almost three in ten (29%) Medicare Advantage enrollees with access to dental benefits under their plan may be required to pay a monthly premium, averaging $284 per year in 2016, for the plan dental benefits.
  • Of the 7 million Medicare Advantage enrollees in plans that offered both preventive and more extensive dental benefits, about four in ten (43%) are in plans with dollar limits on coverage, and most plans had limits around $1,000. In addition to dollar limits, Medicare Advantage plans typically limit the number of services covered.
  • Among full dual eligibles, almost nine in ten (88%) lived in a state where they were eligible for some dental benefits from Medicaid, although the range in covered benefits varies significantly across states.
  • Poor oral health is associated with potentially preventable and costly emergency department (ED) visits, with more than 2 million visits to the ED each year among people of all ages due to oral health complications.

The KFF Issue Brief available at: The Center for Medicare Advocacy’s oral health work:


    Center for Medicare Advocacy Hosts a Webinar
    with Special Guests Medicare Rights Center & Justice in Aging

    Medicare & Health Care Hot Topics
    Wed, Apr 10, 2019 3:00 PM – 4:00 PM EDT

    This presentation will examine several current issues facing Medicare beneficiaries. Topics include: ongoing barriers to care, including home health and observation status issues, Medicare outreach and education, transitions from other coverage to Medicare, prescription drug proposals, and various issues impacting low-income beneficiaries, including Dual-Eligible Special Needs Plans (D-SNPs) and improper billing of Qualified Medicare Beneficiaries (QMBs).


    David Lipschutz, Associate Director/Senior Policy Attorney, Center for Medicare Advocacy
    Lindsey Copeland, Federal Policy Director, Medicare Rights Center
    Jennifer Goldberg, Deputy Director, Justice in Aging

    Register now at:


    The Center for Medicare Advocacy is a non-profit organization.
    Your contributions to the Center are essential to maintaining our ability to advance access
    to comprehensive Medicare coverage and quality health care.

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