South Dakota Stands At A Crossroads: Save Our Facilities From Medicaid Ruin
by Billijean Moerman
As proud South Dakotans, we understand the obligation of prioritizing care for others above all else; for our families, our neighbors, and all those in need. Having access to quality healthcare when needed is a standard necessity of this care that we expect for one another. For this reason, it is imperative that I draw attention to our devastatingly overtaxed, primary funding source of Medicaid.
For many years, Prairie Estates Care Center stood as a beacon of love for our elderly in the small farming community of Elk Point. Some of the most gracious and hard-working individuals called Prairie Estates their home and I was the proud administrator who served them. As with most all facilities, Prairie Estates relied on Medicaid funding to reimburse our gracious owners for the care that we provided. For years, our owners fought and went into debt to keep Prairie Estates open. In January 2023, this battle was lost as Medicaid reimbursement rates barely covered a fraction of the costs.
Our state lost the most caring, loving, close-knit facility I have ever seen in my 24 years in long term care. There was nothing more heartbreaking than to hold my residents as they cried for their home, as we were forced to separate them and move them hundreds of miles away. Many of our residents went to school together and knew one another for much of their lives. They deserved to spend their golden years surrounded by their community and loved ones. Instead, they were forced to go to the only facilities that had room for them. Sadly, Prairie Estates Care Center is just one of over a dozen nursing homes and long-term care centers forced to close in recent years across our state. Over the past five years alone, 10 percent of licensed nursing home facilities in South Dakota have closed due to Medicaid underfunding. According to the South Dakota Department of Social Services, 54 percent of nursing home residents across our state depend on Medicaid for care. At the time when our facility was forced to close in 2023, Medicaid reimbursements in our state totaled $62.5 million. It is highly concerning to see lawmakers in Washington consider proposals that would drastically cut our overly overburdened Medicaid budget. Major new cuts to the program, on top of existing underpayments and inflation, would be devastating.
Medicaid is a program built for families. It serves South Dakotans of all ages, including pregnant mothers and 40 percent of the children born in our state. Patients and families who are the most vulnerable— including those with mental health and substance abuse problems, live in rural counties or have developmental disabilities— rely on Medicaid for care. Organizations and centers established to care for these patients often utilize Medicaid funding. A recent analysis from Georgetown University demonstrated that Medicaid is especially important in small towns and rural areas. One fifth of the country lives in these areas, including a large population of our state.
I, like many red-blooded Americans, admire the efforts of President Trump for championing the voiceless and repeatedly stating he will not cut Medicaid. I support our government in finding greater efficiencies and thank the President and Congress for preserving essential programs like Medicaid as part of this initiative. Trust me when I say that nursing facilities need every penny they make, and Medicaid is crucial in this regard.
So please, don’t wait until your small-town nursing home closes. Don’t wait until you need a compassionate caring environment for your mom or dad and find that they no longer exist. I am speaking for thousands of elderly, but our voices are not strong enough.
what is left out of this guest column is an explanation of what happened to the money, the estates, that the residents had before they became eligible for Medicaid.
They spent it. They got reverse mortgages on their homes, they transferred assets to their kids, they lived in expensive assisted-living facilities.
And then when the money was gone, and the 5 year look-back period ended, they applied for benefits under Title XIX and went into nursing homes.
At the facility where I last worked, the administrator said that around the year 2000, 3/4 of the residents were private pay and 1/4 were on Title XIX. it took only about 10 years for that ratio to reverse, as more and more people with no money left came in. Long term care is no longer a viable business plan, as people figure out they can have Mom and Dad live with them for a mere five years, liquidate the assets, use the money to pay for the grandchildren’s college or whatever, and then drop the old folks off at a nursing home and let the government pay all the bills.
The nursing home owners /operators didn’t create this mess, the government did. They made up the rules, and no surprise, people took advantage of those rules.
Hmmm I guess we just shoot everyone when they hit 75 then and take their stuff via inheritance taxes. There’s a different outcome. Another would be for a government “clawback” office to be started that prevents certain types of liquidations past a certain age, or rolls back $$ from recipients if elder care costs require it.
Can’t help but notice that’s about when pensioners started getting phased out by folks living off 401k’s.
But no one in congress has the courage to create rules about shedding assets to qualify. Democrats want to help people and republicans want to preserve wealth transfer.,
That’s how we got there.
How about the kids help pay for mom and dad? How about families care for their elderly?
Are you aware of the care requirements for a person with dementia?
I have some experience.
And you expect family members to care for a person with late stage dementia? What about Parkinsons, ALS, or any of the numerous medical conditions exacerbated by the frailty of old age? You demand families care for advanced medical conditions they lack any expertise on how to deal with. Shame on you.
What do you suppose families did before the nanny state took over?
Easy, the elderly died of easily preventable injury or disease you absolute muppet.
We also had elderly encampments similar to what you see in 3rd world countries today. These people have never read a history book.
I South Dakota…you’re legally required to:
https://sdlegislature.gov/Statutes/25-7-27
Any adult child, having the financial ability to do so, shall provide necessary food, clothing, shelter, or medical attendance for a parent who is unable to provide for oneself. However, no claim may be made against such adult child until the adult child is given written notice that the child’s parent is unable to provide for oneself, and such adult child has refused to provide for the child’s parent. Notice required by this section shall be given within ninety days after the necessary food, clothing, shelter, or medical attendance, claimed in the notice, was first provided for the parent. However, in the case of fraud or misrepresentation, notice shall be provided within ninety days after such fraud or misrepresentation is known or should have been known. If the parent or someone acting on behalf of the parent makes application for assistance pursuant to chapter 28-13, the county shall give the written notice required herein within ninety days after it receives the application or notice required under § 28-13-1, 28-13-32.3, 28-13-32.4, or 28-13-34.1, whichever is sooner.
As a MAGA I only believe government money should go to “job creators”. How will we pay for this “health care”? You want to tax the millionaires, they will all leave the country. Yes, those same people who have been buying media to convince you that immigrants are the problem, and that we should know no other language than English, will leave and become immigrants themselves. Do you want that? Trump said this yesterday from the Oval Office, so we know it is true. It is time for everyone to thank your billionaire, and by thanking, I mean give them more money, and pay their share of taxes for them.
this isn’t about Trump or billionaires unless you are talking about the ones in Congress, who make up the rules about Medicaid look-backs, gift tax exemptions, and mandatory minimum distributions.
The simple fact is, many of the elderly had money, plenty of money, to pay for their long-term care, but it disappeared, and they arrive at the nursing homes penniless.
So I assume the Trump and Billionaires plan to address this only by looking into the loopholes, then, right? Bipartisan legislation would be an obvious path to address the obvious loopholes. Surely, this won’t be another sledgehammer or chainsaw to the Medicaid/care program to get closer to that $1.5T cut that MAGA is looking for? Surely, we won’t be giving more tax breaks to those billionaires while cutting the services for the lower class. If this isn’t correct, then please enlighten us on the path forward and the potential savings, because anyone looking at numbers is not seeing them match the rhetoric of MAGA…..
There are things going on which could be changed.
In addition to a look-back period of only 5 years which could be changed to 10, the age at which mandatory distributions occur could be raised from 73.
When you turn 73, whether you need the money in your retirement account or not, you are required to start spending it. Might as well gift it to your heirs at the current $19,000 per recipient under the gift tax exclusion. You can give each of your grandchildren $19,000 this year without paying any gift tax. The lifetime gift tax exemption is almost $14 million now.
And you don’t have to turn 73 to start giving your money away. It’s just at 73, when you might be 20 years from needing nursing home care, the government wants you to start spending your money away. And with the gift tax exclusion, they make it easy.
There are so many moving parts in estate management that a lot of things could be fixed.