Kevin Larson found himself in a room with Sen. Ron Johnson (R-Wisconsin) Monday, Aug. 15 in Marshfield.
The administrator of Spring Valley Health and Rehab Center recently told Sen. Sheila Harsdorf (R-River Falls) that the nursing home had taken a turn for the worst.
In 2014-15, long-term care facilities throughout the state of Wisconsin reported a $331.8 million "Medicaid deficit." Long-term care facilities are facing a massive budget shortfall and are struggling to find enough Certified Nursing Assistants (CNAs) to fill out their staff.
This issue isn't new, but it's escalating for Larson.
Harsdorf listened to Larson's concerns and put him in contact with Scott Bolstad, who is the Eau Claire Regional Outreach Director for Johnson.
"I got a call from Scott and he said he was in New Richmond and wanted to stop down to talk with me," Larson said. He agreed to the meeting and, having just stepped out of a meeting with lenders for the facility, he had a lot on his mind. "When he got into my office, that poor guy heard it. I didn't hold anything back.
"Our (Medicaid) reimbursement rates are horrible, the ACA (Affordable Care Act) is killing us, and we can't find people to live here because they can't afford it; but even if we did have the Medicaid funding to cover their expenses we don't have enough CNAs in the workforce to take care of these people.
"It doesn't end and it's coming from multiple directions."
It's a never ending death spiral.
After their meeting, Bolstad offered to set up a meeting with Larson and some other administrators to talk about the issues directly with Johnson.
Larson was skeptical, but said he couldn't turn it down.
Larson was blown away by Johnson in the meeting. Johnson was aware of the issues that were plaguing rural Wisconsin facilities like Spring Valley.
The issue that has the greatest impact on facilities is the low rate of Medicaid reimbursement by the state of Wisconsin.
Medicaid reimbursement for facilities is a joint effort between the federal government and the state to help facilities fund their operations. The federal government allocates a certain amount of money for each state and then the state government decides how much of the remaining costs it can afford to cover.
The state initiates the payment by paying a percentage of the costs each facility is short because of its duty to serve low-income individuals so that they can afford care when they need it.
When Johnson voted against Medicaid expansion, he was accused of being anti-Medicaid. In the meeting, he told the group that the label disappointed him because he likes the Medicaid program. Instead of expanding Medicaid, he wants to make sure that traditional Medicaid is shored up.
On July 27, Johnson said, "Without pulling the rug out from under anyone, let's end further enrollment in Medicaid expansion, and the money we save, as that program phases out through attrition, let's devote that money to traditional Medicaid, supporting and sustaining the elderly, children, and the disabled."
As Congress attempted to repeal ACA, Rep. Ron Kind (D-La Crosse) was worried that Medicaid would be gutted, thus hurting the elderly who use two-thirds of the funding in Medicaid.
Kind's communications director Amanda Sherman said in an email, "The biggest thing is making sure that drastic cuts aren't made to the program. The Congressional Republicans' health care bills all included huge cuts that would have gutted the Medicaid program. Hopefully, given that those bills failed, they don't go down that path again."
The bills ultimately stalled in receiving Johnson's support when he couldn't get a guarantee from Majority Whip Mitch McConnell that the bill would not gut Medicaid. When Johnson eventually came around to voting for the senate to proceed on the "Skinny repeal" bill, it was because Medicaid wasn't going to be touched.
Bolstering Medicaid at the federal level is something that State Sen. Kathleen Vinehout (D-Alma) welcomes. She said it was critical to the livelihood of Americans.
"If Medicaid is cut, people will die," Vinehout said. "That's why it's so important to pay attention to what is happening in Washington. They don't realize that it's most likely not going to be the person in Milwaukee that has three kids, it's going to be the person in Pierce County who can't afford to have their mother in a nursing home anymore and now doesn't have any way to take care of her.
"This is our problem and it's in our neighborhood. This is a big deal because there is so much geography and there are so few nursing homes. The rural nursing homes are going to be hurt first, before the urban nursing homes."
But even if the federal government improves Medicaid, there is no guarantee that the state will take advantage of extra money available, even if that tax money is being collected regardless of the state's decision to accept it back from the federal government.
Two-thirds of the state's Medicaid money goes to long-term care. It's also important because for every dollar the state spends as Medicaid, the federal government pays $1.43. If the state doesn't accept that funding, it either goes without paying for the services, or it has to make up the money on its own.
Vinehout said that money, which she estimated added up to $280 million, could go toward things like mental health, higher education, or the transportation budget. It is money that the state is leaving unclaimed and it has led to facilities like the Lutheran Home in River Falls and the Fall Creek Care Center closing earlier this year.
These closures have the attention of State Rep. Warren Petryk (R-Eleva).
"Aging and long-term care facilities have been struggling — that is undeniable," he said in a statement. "As a legislator, my primary goal is to find solutions for issues concerning my constituents, especially those among us who are most vulnerable."
Part of the problem for struggling facilities is the inability to recruit CNAs because of low wages and amount of time to train.
Petryk introduced Assembly Bill 432, which has also been co-sponsored by Harsdorf and Vinehout, in an attempt to help nursing homes find CNAs faster. The bill would lower the number of hours of training required for a CNA from the Wisconsin standard of 120 hours to the federal standard of 75 hours.
This was an initiative that Petryk alluded to in November following his reelection.
In an attempt to help with the recruitment, the Department of Health Services has received federal approval to invest more than $2.3 million to implement a program designed to add about 3,000 CNAs to the workforce.
"My hope is that this legislation will provide some workforce relief to our wonderful facility in Spring Valley and others across our state," Petryk said.
Whether or not the relief will happen soon enough is the most troubling part for Larson. He has an idea for why that is.
"Well, first it's a complicated issue," Larson said. "It's not like building roads, so it won't get you votes. It's not a ribbon cutting ceremony, or a glamour shot. It's the noble thing to do; it's definitely the right thing to do, but sometimes you gotta put on overalls and go shovel pig shit and deal with it."