Massachusetts pediatric skilled nursing provider Holly Jarek met with congressional staff members recently as part of a lobbying effort by the American Health Care Association (AHCA) to educate lawmakers about the negative impact that a proposed change to the Medicaid payment system would have on those who receive and provide care in the long term and post-acute care setting.

Jarek, chair of AHCA’s Intellectual and Developmental Disabilities (ID/DD) Committee and administrator for Seven Hills Pediatric Center, an affiliate of Seven Hills Foundation in Groton, Mass., spoke to Provider at the annual ID/DD Fly-In in Washington, D.C.

“We’re going to be talking about MFAR [Medicaid Fiscal Accountability Regulation],” she said ahead of the meeting. “I’m going to talk about the impact that a reduction in Medicaid funding would do to my building. It will be devastating, to be frank. We’re not sure if we would be able to continue.”

Seven Hills is a pediatric skilled nursing community that provides comprehensive care to 83 children and young adults with severe developmental disabilities and complex medical needs. The facility is 100 percent Medicaid-funded.

MFAR as proposed by the Centers for Medicare & Medicaid Services (CMS) would cripple Medicaid financing in many states by cutting some $50 billion annually from the program, according to AHCA and other opponents of the policy.

“Basically, we will lose a lot of our quality services in terms of our art program, our therapy, some of our additional activities,” Jarek said. More important, she added, MFAR would “cut deeper and affect our direct care providers.”
“These are the people who take physical care of our residents every single morning. And you can only take care of one resident—it still takes a certain amount of time, and after awhile you just can’t reduce that number [of caregivers] any more without reducing your quality,” Jarek said.

She fears the threat to her facility’s ability to survive MFAR as a worst-case scenario but sees certain labor force reductions if the policy comes to bear.

“And, therefore, our ratio for our staffing and CNAs becomes reduced,” Jarek said. This means in real-life terms that staff tending to the care of children in wheelchairs and having feeding tubes and possibly tracheostomies, would be stretched thin.

“The changes in MFAR would leave you about one hour per day to take care of all these residents’ physical needs, and not only their morning needs, but getting them up and out of bed and into their wheelchairs, getting them to school and to their programming,” she said.

Jarek said the effort to lobby Congress is one that she has been part of for years as an active member of AHCA, and one that has resulted in positive relations with her congressional delegation from Massachusetts.

“I have had wonderful access to my delegation. I see my delegation every year. This is my 10th Fly-In, and I have found that I get access to anyone that I pretty much need,” she said.

This time around the effort to protect and possibly expand Medicaid funding is made even more important because of MFAR and puts Seven Hills and its residents in a perilous state if it were to become regulation.

“We are the only game in the state for what we’re providing. There are only two pediatric providers in the state of Massachusetts. They’re going back to the hospitals if we are not there. There is no other alternative that can provide the level of care these children need,” Jarek said.