Medicaid nursing facility payment in the mid 00s

Medicaid nursing facility payment has been subject to major constraints in recent years. State fiscal shortfalls, expanding Medicaid rolls, federal constraints threatened Medicaid in the early 00s. Although the economy, so state finances, has improved generally the mid-00s, the recent downturns once again threaten state ability to fund Medicaid. The continuing issue is how much varied pressures have affected state Medicaid policy, particularly reimbursement, for NFs. We report newly-available data on Medicaid NF reimbursement rates for three years, 2004-2006, in the context of earlier years. Although the mid-00s showed some state increases in NF reimbursement rates, the record still remained mixed, with some states reducing rates in one or more of the years, and a few maintaining rates basically unchanged. Thus, although overall rates nationally increased more than in the early decade, this masks continued cost-cutting in some regions. Of particular interest, states that had traditionally had the lowest reimbursement rates tended to fairly-large increase in the mid-00s, so that some previously-more-generous states are now among the worst payers. We conclude that recent Medicaid nursing facility reimbursement remains an area of concern and likely to worsen with a faltering economy, with concomitant implications for access, quality, and institutional equity.