When Missouri state legislators passed a special budget to direct federal stimulus spending, it included $90 million to help nursing homes cope with a virus and accompanying respiratory disease that preys on its population of older, ill patrons.

But, as budget veteran Rep. David Wood explained, the budget amount was just a placeholder, giving the governor the authority to spend that money if and when it comes from the federal government.

Treasurer Fitzpatrick presides over working group meeting for CARES Act funding.

The supplemental budget passed on April 8 and the awaited help for the nursing homes may come soon.  Missouri Treasurer Scott Fitzpatrick leads the working group to dispense the money, with the governor’s approval. He says the group will be meeting in the next week or two to review the next allocation of the $1.26 billion remaining from the federal relief funds to the state.

Since then, the estimate of nursing home needs has grown.

At the beginning of the crisis, nursing home needs were overlooked and underestimated, according to Nikki Strong, executive director of the Missouri Healthcare Association, the state advocacy organization for licensed long-term care facilities.

“We put a lot of time, a lot of effort into a really legitimate ask that, in my opinion, still won’t cover the cost nearly what I know now versus what I knew in March,” Strong said. “If we were to do this over again, I would probably say that $90 million does not come near in covering what many of our facilities across the state are incurring to deal with COVID.”

She said the facilities are now getting more access to testing, PPE’s and telemedicine, but can always use more.

Add to that, she said these facilities are “chronically underfunded.”

“We were 26 dollars per patient per day, on average, underfunded based on the cost reports we filed, mandate cost reports. Funding has always been a significant issue. We were in bad shape before COVID, after COVID from a financial perspective, we were in really, really bad shape,” Strong said. She says there have been dramatic increases in food costs, PPE’s, medical supplies, pharmacy, and oxygen.

Fitzpatrick said the formula for handing out this money has changed.

Now, instead of the previous per diem formula, nursing homes will apply for reimbursement for actual costs like PPE or hazard pay.

Fitzpatrick said state budget staff has been stymied by vague guidelines and have until the end of the year to work out the best way to spend the remaining funds.

“We have been hoping and waiting from additional feedback from (the U.S.) Treasury that will help us make better decisions moving forward because what we don’t want to do is get trigger-happy in spending this money really quickly and then find out they’ve made some clarification that would make that use of the money not acceptable or they open up a bunch of different uses for the money and we wish we wouldn’t have spent it the way we spent it,” Fitzpatrick told Missourinet.