Medicaid payments vs. nursing home costs: 5 takeaways

Medicaid payment rates given to the average nursing home covered about 82 cents per dollar of care costs for Medicaid residents, according to a recent federal government report. 

The "Assessing Medicaid Payment Rates and Costs of Caring for the Medicaid Population Residing in Nursing Homes" report was published Oct. 11 by the Office of the Assistant Secretary for Planning and Evaluation. 

Researchers used 2019 Medicaid payment data and cost reports from 13,285 nursing homes across 44 states for the report. Data from 2019 was used to avoid "distortions in payment and costs caused by the COVID-19 pandemic," the report said. 

Here are five things to know from the report:

  1. Medicaid per diem payments covered 80% or less of the per diem costs for about 40% of nursing homes. 

  2. Medicaid per diem payments covered 80% or more of per diem costs for 52% of nursing homes.

  3. Medicaid per diem payments exceeded the per diem costs for 8% of nursing homes.

  4. Not-for-profit nursing homes had the lowest Medicaid payment-to-cost ratio, compared to for-profit and government-owned nursing homes.

  5. Nursing homes with total nursing staff levels below three hours per resident day had the highest average payment-to-cost ratio, at 0.85. Nursing homes with nursing staff levels higher than four hours per resident day had the lowest average payment-to-cost ratio, at 0.77. 

Read the full report here

 

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