Friends Care Community residents Mimi and Wilma. (Submitted photo)
Coverage gains, Medicaid strains at Friends Care Community
- Published: October 8, 2025
Friends Care Community recently cleared a hurdle that will make it easier for area families to keep rehab care close to home: on Sept. 1, the continuing-care campus was added to UnitedHealthcare’s in-network roster for short-term inpatient rehabilitation and outpatient therapy.
The change — the end of a years-long, stop-and-start campaign to win a contract with the national insurer — means people who are discharged from area hospitals with rehab orders can now use UnitedHealthcare coverage at Friends Care without facing steep out-of-network bills or, in some cases, having to travel an hour or more to the nearest contracted provider.
“Friends is so grateful for the UHC contract because we will finally be able to serve individuals who have United Healthcare insurance instead of having to disclose that we are not a contracted provider. We are now classified as ‘in-network,’” said Julie Lesley, Friends Care’s director of marketing and development, in a press release announcing the contract earlier this month.
“We were working on this before 2020,” Lesley said in a recent interview at Friends Care, recalling the start of efforts to reach a contract. Negotiations picked up in January 2024, when Friends — a nonprofit provider of long-term care, assisted living, independent cottages and rehab services — sought help from a trade association, Leading Age Ohio, to make their case to insurers.
Though the new contract is cause to celebrate with regard to expanded access for patients, Executive Director Mike Montgomery said that, as an independent, nonprofit facility, Friends Care is always challenged by financial needs.
According to data from the CDC and health policy organization KFF, Medicaid covers more than 60% of residents in nursing homes, about 20% of people in assisted living, and more than half of all long-term care residents nationally. President Trump’s “One Big Beautiful Bill Act,” signed in July, is expected to reduce Medicaid spending and alter eligibility in Ohio, potentially cutting as much as $37 billion in federal funding to the state over the next decade.
Medicaid shortfalls have long been an issue for long-term elder care facilities — “Our Medicaid rate is around $228 per person per day, but our costs are around $280 per day,” Montgomery said — but the impending cuts threaten to shave margins even closer for facilities like Friends Care.
Though staffing is the largest cost for Friends Care, Montgomery said it’s also the facility’s greatest asset.
“The staff here are phenomenal — and some have been here for years, since we opened,” he said. “I like to say I’m the least important member of staff; if I’m not here [residents] might not notice, but if the aides don’t show up or the cook doesn’t show up — they’re some of the most important people.”
Walking through the halls of Friends Care, Lesley showed off the facility’s rehab therapy gym, where therapists worked with several patients who were using the specialized equipment. Elsewhere, residents came and went, eating meals served by staff, watching “Gilmore Girls” in a communal living room and chatting with staff in the halls.
Along the walls were art pieces created by residents via the Scripps Opening Minds Through Art program, which encourages artists with dementia, through volunteer aid, to “rely on imagination instead of memory and focus on remaining strengths instead of lost skills,” according to a program description accompanying the exhibition of works. Around the corner, in a separate, but connected wing, class was in session for the young students of Friends Preschool, where intergenerational activities are part of the curriculum.
Lesley showed off the facility’s family room, where family visitors can gather with residents, and the activities room, where she said a lot of residents gather weekly to play bingo.
“We have an activities staff that’s really instrumental in getting people involved,” she said, adding that Friends Care exclusively offers private rooms for its residents in long-term care.
“Sometimes people just want to stay in their rooms, and that’s fine; the activities staff will go and do one-on-one activities with them,” Lesley said.
The nursing staff, too, is critical for residents, Montgomery said. Friends Care currently has 48 residents who require care from the nursing staff; according to a state-mandated weekly census posted within the facility, last week there were 20 members of nursing staff on duty during various hours to care for residents. According to data from medicare.gov, Friends Care provides an average of five hours and 31 minutes of nurse staffing per resident per day — higher than the national average of three hours and 51 minutes and Ohio’s average of three hours and 40 minutes.
It’s important, Montgomery said, that Friends Care retain its high ratio of staff to residents — a choice continually made by the facility’s board of directors, made up of members from both the Yellow Springs Friends Meeting and the wider village community. At some larger, for-profit facilities, he said, cutting staff would often be the first response to financial pressures.
“With reimbursement being slashed like crazy, we’re not getting a fair share; I’ve been in places where I’d get a call saying, ‘Cut expenses 10%,’ and that means cutting staff — we don’t want to do that,” he said.
“We really, really rely on donations,” Lesley added.
With that in mind, Montgomery pointed to support from the wider Yellow Springs community during the pandemic — during which Friends Care was among the less-than-1% of long-term care facilities to have zero cases of COVID among its residents — as paramount for the facility. He also noted the recent Feast for Friends fundraising event, which raised nearly $8,000 for the facility’s goal of purchasing a van with a wheelchair lift. Once purchased, the van will provide easier access to off-site locations for residents in general, and help Friends Care fulfill its state-mandated obligations to provide medical transportation for rehab patients and long-term residents.
“The support we get from the community is great, and I value it like you would not believe,” he said. “And we will need more and continued support if the village really wants us to continue.”
Montgomery is set to retire in about six months; he noted that, though “keeping the lights on” at Friends Care has been a challenge, and will remain so for his successor, he’s proud of the facility’s five-star rating from the Centers for Medicare and Medicaid Services — but even more proud of the care staff has brought to residents. He said he especially loves when children of residents report that, because Friends Care has taken over caregiving duties for a parent, their parent-child relationship has been restored.
“They say, ‘I was the caregiver telling Mom to go to bed or take her medicine, and now that’s your job — and I have my mom back,’” Montgomery said. “That’s probably my biggest joy.”
Lesley added that she hopes the wider community will remain proud of Friends Care, too. She said that, particularly during this time of uncertainty for long-term care facilities, she hopes those unfamiliar with the facility and its work will come out to future community and fundraising events, or add their names to the list of community volunteers who spend time with residents.
“Get to know Friends and see how special it is in the landscape of healthcare; be proud of Friends,” she said.
For more information on Friends Care Community, including how to donate or sign up to volunteer, go to http://www.friendshealthcare.org.
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