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The 130th Annual Meeting of APHA |
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The 130th Annual Meeting of APHA |
James H. Swan, PhD1, Saraswathy Ramachandran, MA1, Padma Gulur, BDS1, Dipti Patel, MBBS1, Atiq Syed, MBBS1, and Charlene Harrington, PhD2. (1) Department of Public Health Sciences, Wichita State University, 1845 N. Fairmount, Box 152, Wichita, KS 67620-0152, (316) 978-5634, swan@chp.twsu.edu, (2) Department of Social & Behavioral Sciences, University of California San Francisco, 3333 California St, Suite 455, San Francisco, CA 94143-0612
Medicaid reimbursement for nursing facility care has been of concern, especially since the Boren Amendment was repealed in 1997. Likewise, funding allocations for direct patient care has been an issue. We report data on reimbursement rates and policies affecting patient care versus other cost centers. Only two states show lower reimbursement rates in 1999 over 1998, none showing unchanged rates. Data for 1997-1998 show only three states decreasing rates, two with unchanged rates. Adjusted for CPI, ten states increased rates 1998-1999 by less than inflation, while one exactly matched inflation; and only nine showed 1997-1998 decreases. Thus, most states show evidence of rate increases after the repeal of Boren, suggesting 'room' in Medicaid rates for more money for direct care. The question is how state policy may have influenced whether greater funding likely went to such care. In 1997 data, of 48 states that reported using cost centers, 47 included nursing and patient care, of which 38 reported limiting reimbursement, and 8 restricting expenditures. By contrast, of 44 that included capital, only 21 limited reimbursement and 6 restricted expenditures, including one that did not limit reimbursement. This showed a slight drop in limits on nursing and a slight increase in limits on capital from data previously reported for the early 1990s; but this does not represent major policy change from that period. In sum, in most states, nursing facilities averaged rate increased post repeal of Boren, but there is little evidence of a shift toward greater funding for direct care.
Learning Objectives:
Keywords: Financing, Long-Term Care
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.