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Providers press DHS over assisted‑living Medicaid rate study; committee leaves rule 'not reviewed' and DHS will withdraw to consult
Summary
DHS proposed raising an assisted‑living Medicaid waiver per‑diem to $68.51 based on a Milliman cost study; assisted‑living providers said the actuary's calculations and raw data did not reconcile, warned the proposed rate won't cover higher wages, and sought an outside review. The committee allowed DHS to withdraw the rule for further stakeholder work.
The Department of Human Services presented an amendment to the 'Living Choices' Medicaid waiver that would change the assisted‑living per‑diem previously set to an ultimate $62.89 to a revised $68.51, citing a second cost survey and an actuary review by Milliman.
Mark White of DHS told the Senate Public Health committee that Milliman conducted the actuarial review and that the agency followed a second industry cost survey to re‑evaluate the rate. The proposal also included non‑substantive housekeeping changes to background checks and past recipient eligibility.
Several assisted‑living operators and industry representatives objected. They said they either could not access the underlying data or could not reproduce Milliman's calculations from the raw files. One provider told the committee that the survey's median wage figures for nurse aides did not match the raw submissions and that overhead ranges cited in Milliman's letter differed from the published study results. Providers said many had not received a rate increase since 2014 and that recent minimum‑wage increases had raised labor costs substantially.
Todd Hightower and other operators urged a delay and an independent review. Provider testimony included examples of facilities unable to staff at the proposed rate: "With the rate we're gonna have at $68, you cannot staff the entire building with minimum wage and still have it cash flow," one operator said.
Committee action: Senator Hammer moved to pass out all rules except the rate sections and to invite Milliman to the next public health committee meeting. An alternate motion to pass the rule in its entirety failed on a voice vote. DHS offered to pull the rule, consult with stakeholders and return; the committee agreed to allow DHS to withdraw the rule and the rule was recorded as not reviewed (DHS will return with revisions or additional materials).
