St. Louis City nursing homes shrinking as Medicaid rates, unpaid "Medicaid pending" bills squeeze operators

Nancy Stevens, a representative of Berry City and Community Agencies, told the St. Louis City Health and Human Development Committee that low Medicaid reimbursement and large unpaid Medicaid-pending balances have made it financially untenable for several city nursing homes to continue operating.

Stevens summarized the problem to the committee: Missouri's Medicaid rates use a complex matrix and do not cover the rising costs of care, especially after COVID-19 drove up staffing prices. "Some of the facilities had Medicaid pending up to and including close to $3,000,000," she said, describing how facilities can carry unpaid claims for months while waiting for state adjudication.

The matter matters locally because the closures displace residents and create vacant, unsecured properties that attract vandalism and shelter people experiencing homelessness. Stevens cited recent closures and ownership changes in St. Louis City, including Northview Village, Riverview and Dutchtown, and said those losses strained both long-term care capacity and neighborhood safety.

Stevens described two separate revenue streams for nursing homes: short-term Medicare payments for post-hospital rehabilitation and longer-term Medicaid daily rates for residents who qualify. She said Medicaid daily rates cited in her presentation ranged roughly from $165 to $180 per resident, amounts she said do not cover housing, 24-hour nursing availability, daily care by CNAs or CMTs, medications and other operating costs. At the same time, she said, staffing costs rose substantially; in some cases, hiring an LPN/RN or contract nurse cost 50 to 120 percent more than prior pay scales.

Stevens also described administrative bottlenecks. She said facilities that admit residents not yet enrolled in Medicaid must apply through a layered state-federal process and enter a status known as "Medicaid pending." That application process, she said, runs through an online portal (referred to in the presentation as "Comru") and can be months behind, leaving facilities to carry the cost of care without reimbursement.

The combination of lower-than-average Medicaid rates, rising labor costs and large Medicaid-pending receivables has, Stevens said, prompted owners—many family-run—to sell or close facilities rather than subsidize operations. She recommended the committee consider gathering city-level data (including a ward-level breakdown) to show legislators how St. Louis compares with other Missouri localities and neighboring states.

Committee members thanked Stevens for the overview and several members said they would like a follow-up presentation with updated financial figures and a county/city breakdown of the recently released Medicaid rates.

Stevens concluded by stressing the link between nursing home decline and homelessness in some neighborhoods: when a facility closes, displaced residents and staff must find new placements or employment, and vacant multi-story buildings can quickly become security and public-safety concerns for adjacent wards.

Stevens said she would forward updated Medicaid-rate analyses and clarified data for committee review if the committee requests a return visit.