I am pleased to report that my grandson Caleb will be Spider-Man for Halloween this year. He is primed and ready with his costume for Trick-or-Treating and now must only wait.
Watching him grow is so fun. Now, at age 4, I can have actual conversations with him. He can tell me about his friends at day care and the things he is enjoying and looking forward to. This is a delight. I wish that my youngest daughter and her family weren’t eight hours away, but we do video calls every Sunday and visit as much as we can.
I reported today on Hospice News that Medicaid managed care plans in California are continuing to fail to reimburse hospices for room-and-board for dual-eligible patients in nursing homes. This has been going on for years, and it has to stop.
Some providers are still owned payments dating back to 2023. The amounts total in the millions of dollars. While this issue is affecting hospices of all sizes, this is particularly difficult for small operators who can’t shoulder such losses without harm.
We first reported on this in 2025, and Hospice News received an Azbee Award for Business Journalism for our coverage. I won’t repeat all the details that are in the stories here, but please check out the links.
These Medicaid plans need to get their acts together immediately and start processing these payments. They are supposed to be a “pass through.” The hospices pay the nursing home, and then the health plan reimburses them. Under California state laws, you don’t have to be in the payer’s network to receive those funds.
If the plans don’t do this on their own, then the State of California must intervene to enforce the law.
Last year, the state issued an All-Plan Letter to its Medicaid payers instructing them to make these reimbursements. Now, further action is necessary to restore and preserve the financial health of hospice providers and ensure access to care in their communities.
What I am curious about is whether or not this is happening in other states. Have you seen similar tendencies among payers in your markets? Please let me know in the comments.