Nebraska saw nine long-term care facility closures in 2022, second only to 13 in Texas.

In the past three years, Nebraska has lost a combined 29 assisted living facilities and nursing homes. Inadequate funding for Medicaid patients, workforce issues and the rising costs of goods and services have all contributed to these closures.

Two bills to be heard in the Unicameral's Appropriations Committee today would mean substantial increases in state and federal funding for both types of facilities.

Jalene Carpenter, Nebraska Health Care Association CEO, says additional funding is crucial to stem the state's long-term care crisis.

"In Nebraska, 15 counties do not have a nursing home or an assisted-living [facility], and we are really starting to see a 'care desert' be created. And that causes significant issues for Nebraska seniors, " Carpenter expressed.

LB-941 would increase the daily reimbursement rate for assisted living residents on the Medicaid Waiver program. The new daily rate of just under $79 is based on a Nebraska Department of Health and Human Services study. LB-942 would increase the nursing home Medicaid reimbursement rate by about 5% over the next year. Both bills were introduced by state Sen. Myron Dorn, R-Adams.

Carpenter says the COVID-impacted long-term care workforce is improving in the state, but she stresses Medicaid reimbursement rates play a large part.

"A large portion of the Medicaid rate -- when you look at what it covers -- it's primarily going towards labor and benefits. Nursing-facility and assisted-living care is very hands-on, and we need adequate rates to be able to attract and retain team members," she added.

Carpenter said the state, educational institutions and organizations, including the Nebraska Health Care Association, are also focused on building the long-term care workforce -- including introducing young people to careers in health care and strengthening Certified Nursing Assistant programs.

"We're trying not only to increase the rates so that our facilities can attract and retain (employees), but then also, as an association, to look at other ways to drive people into the workforce for this profession, " she said.

In 2023, Gov. Jim Pillen approved a one-year, 3% increase in the Medicaid reimbursement rate, but vetoed the Legislature's 2% increase for the second year.

More than 580,000 Wisconsinites are unpaid family caregivers and they serve as the backbone of the state's long-term care system, and one organization advocating for seniors said the state could do more to acknowledge it.

Family caregivers often go without vital support, even as they provide an estimated 538 million hours of care to loved ones each year, according to AARP data.

Martin Hernandez, associate state director of advocacy for AARP Wisconsin, said while the holidays can bring added stress to their already full plates, times like these are when important discussions should happen.

"This is an opportunity to come together with family and friends and have those open and frank conversations that people should be having about caregiving," Hernandez urged. "Both in the situation they might be currently, but then also planning for the future."

It's estimated caregivers spend on average about $7,000 a year on related out-of-pocket expenses. He noted AARP Wisconsin will ask state legislators to once again consider a tax credit for family caregivers of up to $500 in the next session. A bill in Congress for a larger, federal tax credit for caregivers has sat in a U.S. House subcommittee for almost a year.

Expanding the state's family medical leave law to include up to 14 weeks of paid leave is also needed, Hernandez argued. Eight in 10 caregivers say they juggle interruptions to their work schedules, including having to change their work hours or leave early.

"Oftentimes there's different barriers, whether those are cultural or economic, where people don't necessarily want to see this as a 'transaction' that has to do with their pocketbook," Hernandez observed.

Proponents also hope the state will prioritize the needs of caregivers and the state's aging population as they develop the next state budget, which could include adopting the Medicaid expansion. Wisconsin is one of 10 states to not yet expand its Medicaid program, which would extend eligibility to about 91,000 more residents.

A new report showed how states such as Connecticut are allocating Regional Greenhouse Gas Initiative funds.

The report from the nonprofit Acadia Center found the 11 states participating in the initiative are using the funds on a variety of initiatives. Connecticut has allocated up to 80% of its funds for clean energy projects. However, some advocates said there are ways the funds can be put to better use.

Paola Moncada Tamayo, policy analyst for the center, said New Jersey serves as a model for other initiative states.

"They have a plan which they publish and that plan goes through a period of public comment," Tamayo explained. "They go through several iterations of the public comment period. They also publish a dashboard which has all the investments they do."

The report recommended states such as Connecticut consider increasing funding investments in environmental justice, including requiring at least 40% to 50% of initiative funds be invested in environmental justice and other underserved communities. The Connecticut Environmental Justice Mapping Tool showed the highest concentrations are located around larger urban areas such as New Haven, Hartford, Bridgeport and Danbury.

Advocates said the recommendations can better hold states accountable for how their funding is spent. The report found some underreporting occurring, which benefits some states' narratives of how the money is being spent. Tamayo acknowledged implementing the report's recommendations could prove challenging.

"I'll say probably in some states, there has been lack of funding and so they've been trying to fill funding holes from it," Tamayo observed. "Other states might just be that they don't have the manpower to do the level of reporting that we would want them to do."

Tamayo hopes the improvements will be implemented so states such as Connecticut can make better use of their initiative funding. While it has not been front and center, she feels it has been an important tool for helping states decarbonize.

President Joe Biden has entered a "lame-duck" period, prompting a Michigan political science expert to analyze his potential actions before President-elect Donald Trump takes office in January.

Outgoing presidents typically work on a smooth transition while the president-elect fills key positions. As Biden nears the end of his term, he has approved long-range missiles for Ukraine to strike inside Russia, marking a significant shift in U.S. policy.

Jordan Cash, assistant professor of political theory and constitutional democracy at Michigan State University, examined the possible reasons behind Biden's actions.

"He's trying to find some way to push Ukraine and Russia to a certain end point in the war," Cash explained. "Perhaps to get a final foreign policy victory to vindicate his administration at the end, or perhaps because he fears the way President-elect Trump is going to approach the Ukraine war."

Most political experts agree with Congress divided, it is unlikely much will be accomplished before the new session starts in January. However, they said it wouldn't be surprising if Biden takes other bold or controversial actions as he prepares to leave office.

Cash pointed out while lame-duck periods can have advantages, such as settling electoral disputes or confirming votes, they also come with risks. He warned an extended lame-duck phase, which is typical in the United States, can encourage an outgoing president to make partisan decisions, potentially leading to actions driven more by political motivations than the public good.

"Bill Clinton commuted several dozen sentences, including for Mark Rich, who had been convicted of tax fraud but whose wife was a major Democratic donor," Cash recounted. "President-elect Trump commuted a bunch of sentences including pardoning his former adviser Steve Bannon."

The term "lame duck" originally referred to a financial trader on the London Stock Exchange in the 18th century who defaulted on debts. It was later adapted to describe politicians with reduced influence or authority.


get more stories like this via email