Nursing home owners and workers have told Minnesota legislators that they aren't getting enough money from the state to stay open and to keep the best staff in their facilities for years.
This year, however, the political climate is different. The state has a $1 billion surplus and Republicans, who control the Minnesota House, campaigned on the issue during the 2014 election.
With Minnesota's elderly population on the rise, nursing home industry group Care Providers of Minnesota president Patti Cullen said there is an opportunity to reach legislators.
"They know the silver tsunami, they know the story about the demographics and now it's time. I do think there's a recognition that, 'Who can be against seniors?' "
Care Providers represents many of Minnesota's 370 nursing homes and is part of a coalition that is advocating for a $200 million plan that would completely overhaul how nursing homes are reimbursed. That's on top of a $30 million funding increase the industry got during the last session.
Nursing homes currently get reimbursed by Medicaid in a combination of state and federal dollars. But Cullen said the system has created a lot of problems. Previous budget cuts have meant reimbursements haven't kept up with inflation. And state laws prevent nursing homes from charging private patients more than what Medicaid pays.
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The resulting funding gap has forced some nursing homes to close, often in rural parts of the state populated with elderly people who need them most, Cullen said. It has also meant that facilities are losing their best nurses to better paying jobs at hospitals.
A big part of the nursing home proposal would link more public money for higher nurse salaries to better quality of care, Cullen said.
"We want to make sure that folks who work really hard to have consistent staffing, good employees, satisfaction results, good surveys, that they get the maximum amount of increase as opposed to those who don't have that as a top priority."
The proposal also attempts to equalize reimbursement rates between rural and urban parts of the state, and expand health insurance options for employees.
The nursing home proposal already has support among some key Republicans in the Minnesota House, including Aging and Long-Term Care Policy committee chair Joe Schomacker of Luverne.
He said the plan is part of a slate of House bills aimed at Minnesota's aging population, who tend to live in higher concentrations in the rural parts of the state, precisely where Republicans won seats in 2014 and where most of the state's nursing homes are located.
Schomacker acknowledged that it is a big request.
"Two hundred million dollars is what we're underfunding our nursing homes at this time. That's not going to be a direction we can take too much longer without some serious repercussions."
In the Senate, more nursing home funding has the backing of DFL Human Services Finance Committee chair Tony Lourey, but he wouldn't comment on the legislation's price tag.
The bill would also make a stop in the House Health and Human Services Finance committee chaired by Republican Matt Dean of Dellwood. Dean's committee would have some say in how much the state spends. And at first glance, Dean said he isn't turned off by how much nursing homes are looking for, but he added that the funding may come at the cost of other programs.
"We won't look at that in terms of what's left in the surplus, but what are our overall priorities and really question all of our spending," Dean said.