Sick Kids Pay the Price for Low Home Health Medicaid Rates

There’s a major lack of home health care for sick children in California, and local lawmakers are blaming too-low state Medicaid reimbursement rates for the problem.

In fact, state and industry data, as well as testimony from California skilled nursing facilities, parents and hospitals, indicate that there are major home health care accessibility issues statewide, according to the NBC News Bay Area affiliate.

In many California counties, when medically fragile children are discharged from the hospital, they do not have access the resources that are guaranteed to them by the state’s Medicaid program, Medi-Cal.


“We are not following through on a promise for some of the sickest kids in California,” North Bay Senator Mike McGuire told NBC News Bay Area.

In Napa County, none of the skilled nursing agencies on the county’s list of providers can provide home health care for children, NBC News reported. Two other counties, Sonoma and San Francisco, blame the low acceptance of Medi-Cal reimbursement rates for the difficulty placing pediatric patients with in-home nursing agencies.

The current Medi-Cal reimbursement rate is $40.47 per hour for a registered nurse and $29.41 per hour for a licensed vocational nurse, and the rates have not risen in 15 years, NBC News reported.


Some California lawmakers believe boosting reimbursement rates will increase access to home health services statewide. McGuire, for instance, recently proposed legislation to increase the Medi-Cal reimbursement rate for home care nurses by 20% in three test locations in California, including the Bay Area, NBC News reported.

Increasing wages could incentivize nurses to work in the home health care industry, and more nurses could result in greater access for thousands of children in California who depend on Medi-Cal services, McGuire believes.

Numerous California home health agencies have been moving resources away from caring for Medi-Cal patients, and nearly every single Medi-Cal certified agency reports being unable to staff all the hours approved for their Medi-Cal patients, according to an analysis of state data undertaken by Leavitt Partners LLC, a Utah-based business management consultancy.

Written by Mary Kate Nelson

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