Jackson County medical care facility reports $3.6 million Medicaid repayment, posts $4.26 million negative change in net position for 2024

Destiny, director of the Jackson County Medical Care Facility, told the Jackson County Board of Commissioners that the facility recorded a $3,600,000 repayment to Medicaid in the November financials, contributing to a negative change in net position of $4,257,607 for 2024.

The director said November revenue was $35,917 above budget while expenses exceeded budget by $190,550, producing a net operating loss of $15,433 for the month. For the year through November, facility revenue was $23,913 positive while expenses were $1,100,690 over budget; after accounting for the Medicaid repayment and other nonoperating items, the facility showed the $4,257,607 negative change in net position.

"That number is quite staggering. So I wanted to make sure that we were all on the same page of what that number included," Destiny said as she presented the November and 2024-to-date figures.

Commissioners and staff focused on census volatility and payer mix. The director said average daily census for 2024 was about 180.63 residents in a licensed capacity of 194 beds and that long-term residents make up roughly 75 percent of the census. As of the meeting the facility reported a census of 176, with 20 residents accepted at the hospital and five expected admissions that day.

Chair Shotwell and other commissioners emphasized the difference in daily reimbursement between Medicare and Medicaid: "Typically on a Medicare resident, we're being paid between about 5.30 to 5.60 per resident per day. For a Medicaid resident, we are around 3.35 per resident per day," Destiny said, explaining why maintaining some Medicare (short-term) admissions is important to the facility's finances even as the facility's mission serves Medicaid residents.

The director said days cash on hand, excluding the Medicaid repayment earmark and certain invested/MOE (maintenance-of-effort) funds, is estimated at 26 days. She said MOE funds of about $4,500,000 exist countywide and that the facility projects using about $168,000 of MOE for bond interest expense related to November.

Commissioners asked about accounts receivable (AR) days and write-offs for older items on the aging report; Destiny said management has increased quarterly write-offs and continues collection efforts on large accounts. Several commissioners pressed staff to continue work on admissions processes intended to smooth short-term census swings caused by rehab admissions who promptly return home.

The chair entertained a motion to receive the financial report; the motion carried with all voting "aye."