Medicare Advantage growth, changing payer mix squeeze Connecticut nursing home revenues, consultants tell DPH committee

Connecticut is seeing a growing share of Medicare beneficiaries enrolled in Medicare Advantage plans — and that shift is reducing revenue available to nursing homes, presenters told the Department of Public Health (DPH) Health Care Quality and Safety Committee during a presentation and question-and-answer session.

Jenny Bassey, director of health care policy and innovation at CliftonLarsonAllen (CLA), told the committee that Medicare Advantage now covers a majority of Medicare-eligible people nationally and that Connecticut’s statewide Medicare Advantage penetration is about 57 percent, with notable variation by region. "Medicare Advantage is going to continue to grow," Bassey said, and its capitated payment structure generally results in lower per-patient payments to nursing homes compared with traditional Medicare fee-for-service.

The difference matters because nursing homes have historically relied on Medicare fee-for-service revenue as a relatively higher-paying source to help offset lower Medicaid reimbursement. Nick Mazzato, principal cost analyst at the Department of Social Services (DSS), said Connecticut nursing home census has remained "relatively consistent" at "anywhere from 86 to 87% on a monthly basis," and he reviewed…