Nebraska saw nine long-term care facility closures in 2022, second only to 13 in Texas.

In the past three years, Nebraska has lost a combined 29 assisted living facilities and nursing homes. Inadequate funding for Medicaid patients, workforce issues and the rising costs of goods and services have all contributed to these closures.

Two bills to be heard in the Unicameral's Appropriations Committee today would mean substantial increases in state and federal funding for both types of facilities.

Jalene Carpenter, Nebraska Health Care Association CEO, says additional funding is crucial to stem the state's long-term care crisis.

"In Nebraska, 15 counties do not have a nursing home or an assisted-living [facility], and we are really starting to see a 'care desert' be created. And that causes significant issues for Nebraska seniors, " Carpenter expressed.

LB-941 would increase the daily reimbursement rate for assisted living residents on the Medicaid Waiver program. The new daily rate of just under $79 is based on a Nebraska Department of Health and Human Services study. LB-942 would increase the nursing home Medicaid reimbursement rate by about 5% over the next year. Both bills were introduced by state Sen. Myron Dorn, R-Adams.

Carpenter says the COVID-impacted long-term care workforce is improving in the state, but she stresses Medicaid reimbursement rates play a large part.

"A large portion of the Medicaid rate -- when you look at what it covers -- it's primarily going towards labor and benefits. Nursing-facility and assisted-living care is very hands-on, and we need adequate rates to be able to attract and retain team members," she added.

Carpenter said the state, educational institutions and organizations, including the Nebraska Health Care Association, are also focused on building the long-term care workforce -- including introducing young people to careers in health care and strengthening Certified Nursing Assistant programs.

"We're trying not only to increase the rates so that our facilities can attract and retain (employees), but then also, as an association, to look at other ways to drive people into the workforce for this profession, " she said.

In 2023, Gov. Jim Pillen approved a one-year, 3% increase in the Medicaid reimbursement rate, but vetoed the Legislature's 2% increase for the second year.

Missouri's House of Representatives approved a budget of about $51 billion just before a Friday 6 p.m. deadline.

Gov. Mike Parsons has labeled it the "largest supplemental budget in Missouri's history," and can either accept it as-is or make cuts.

Rep. Cody Smith, R-Carthage, the House budget chair, expressed satisfaction for managing to boost funding for education and infrastructure without risking budget shortfalls. He mentioned a surplus of more than $1.5 billion in general revenue, to be used for potential growth or future projects.

"We've got a balanced budget, we've got less spending than we did have last year, and we've got a healthy rainy day fund," Smith outlined. "I think that package is what I'm most proud of."

Smith is especially pleased with the infrastructure spending for Interstate 44 repairs but expressed disappointment in the budgeting process, due to the lack of a conference committee and challenges in the final weeks. Still, he described the final budget as "strong."

Sen. John Rizzo, D-Independence, the Senate Minority Leader, told reporters a special session could be needed due to the budget being "rushed" and the possibility of other issues coming up.

Rep. Crystal Quade, D-Springfield, the House Minority Leader, also shared her dissatisfaction with the budgeting process.

"We cannot allow the 'new normal' for spending taxpayer money to become just two guys writing a budget in secret and then jamming it through the process at the very last minute, full of pork and appeasing lobbyists," Quade stressed.

Quade described the budget as being completed in the "technical sense" but feels lawmakers deliberately low-balled spending, as several are competing in Republican primaries for statewide offices. She pointed out it is a strategy allowing them to claim credit for cutting overall state spending.


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Child care advocates are pushing for increased funding as the budget deadline approaches this Friday.

Robyn Schelp, director of policy and advocacy for Kids Win Missouri, said ensuring increases to child care subsidies remain in the budget are vital for every Missourian whether they have children or not.

"It impacts the entire workforce," Schelp pointed out. "We have to stop thinking that this is a parent's issue. It isn't. If we want teachers in the classroom and doctors at their offices and whatnot, we have to make sure there's childcare for their kids."

The legislature adjourned after just about 10 minutes on Monday, following a record 41-hour filibuster which went to 4 a.m. Thursday without agreeing on a budget. Missouri lawmakers have only missed the budget deadline one time, in 1977.

Sen. Cindy O'Laughlin, R-Shelbina, the Senate Majority Leader said on social media Friday the Missouri Freedom Caucus only yielded the floor under the threat of a motion to end debate. She tried to introduce the Federal Reimbursement Allowance, which she said is crucial for funding to offset general revenue and vital for Medicaid services.

The budget includes child care subsidies under House Bill 2002. Schelp noted the House's proposal would support only 23,000 children, restricting expansion and compliance with federal guidelines.

"Our hope is that it stays with the governor's recommendation, of that $52 million," Schelp emphasized. "Allowing them to go to that 100th percentile of payment for infants and toddlers and then the 65th percentile for preschool and afterschool."

Sen. Bill Eigel, R-Weldon Spring, is leading an effort to convince fellow members of his party to approve abortion restriction legislation and a bill on ballot initiatives in Missouri before agreeing to a vote on the reimbursement allowance.

A plan to use public money to fund vouchers for students to attend private schools is drawing pushback from Louisiana teachers, who say the plan could devastate the public school system.

The program making its way through the Louisiana Legislature would be first available to low-income students and by the 2027-2028 school year, it would be available to all students.

Larry Carter, president of the Louisiana Federation of Teachers, predicts the plan could cause significant budget cuts for public schools.

"These universal voucher bills are a step in the wrong direction," Carter argued. "We've seen in other states around the country, like Arizona and Ohio, where these bills have been passed, they're now facing a budget crisis, and we're hoping that we cannot go down that same road."

Carter pointed out the education savings account program known by the acronym LA GATOR would allow as much as $7,500 per student from families below 250% of the Federal Poverty Line, and $5,000 for those who make more.

The plan, House Bill 745 and companion Senate Bill 313, has been approved by the state House. The Senate is expected to vote on it by Friday or Monday.

Carter explained teachers are concerned classroom standards currently mandated for public schools would not be upheld in private or parochial schools.

"We want to make sure it has some accountability," Carter emphasized. "We think that's at least giving all education stakeholders and parents an opportunity to talk about whether this program is successful or not. And through accountability practices, we think that will help."

There is concern the plan would force public schools to eliminate many positions and needed programs. Carter fears the loss of funds could deprive students of the benefits of a public school education.

"If we're cutting that funding stream, Louisiana students will have fewer nurses and counselors, less options for after school program, and certainly limited access to field trips and AP courses that help prepare them for their next step in life," Carter outlined.