Pa. hearing spotlights House Bill 1310 to set floor for nursing‑home Medicaid rates

HARRISBURG — Lawmakers, state officials and long‑term‑care providers spent a House Aging and Older Adults Services Committee public hearing debating House Bill 1310, which would set a 0.90 minimum for Pennsylvania's Budget Adjustment Factor, the adjustment the state applies to nursing‑facility Medicaid per‑diem rates when the legislature’s appropriation falls short of the department’s calculated rates.

Supporters said a statutory floor would bring predictability to a system they call unsustainable; opponents, including senior officials from the Department of Human Services, said a floor would remove the General Assembly’s budget flexibility and obligate the state to hundreds of millions in additional annual spending.

The bill and the dispute over the Budget Adjustment Factor, or BAF, matter to thousands of residents, government budgets and providers across the commonwealth. Medicaid (known in Pennsylvania as Medical Assistance) is the primary payer for many nursing‑facility residents; providers and unions told the committee that current funding plus workforce shortages have forced operators to reduce census, sell properties and take beds offline.

Juliet Marsala, Deputy Secretary for the Office of Long‑Term Living at the Pennsylvania Department of Human Services, and Dan Schar, the department’s Bureau of Finance director, told the committee that the BAF was created to align Medicaid nursing‑facility payments with the amount the General Assembly actually appropriates. Marsala and Schar said Pennsylvania uses a case‑mix methodology to calculate base per‑diem…