Medicaid nursing facility reimbursement methods: 1979-1997

Area of Science:

• Health Services Research
• Health Economics
• Public Health Policy

Background:

• State Medicaid programs are crucial for funding nursing facility care.
• Reimbursement methods significantly influence provider behavior and service availability.
• Understanding historical trends in Medicaid reimbursement is vital for current policy analysis.

Purpose of the Study:

• To describe state Medicaid nursing facility reimbursement methods and rates from 1979 to 1997.
• To analyze the evolution of reimbursement methodologies over time.
• To assess the trends in Medicaid per diem rates relative to inflation and general health costs.

Main Methods:

• Data collection via telephone surveys of state Medicaid reimbursement.
• Analysis of reimbursement methodologies, including prospective and casemix approaches.
• Comparison of Medicaid per diem rate increases with inflation and general health costs.

Main Results:

• The 1980s saw a shift towards prospective reimbursement methodologies.
• Casemix methods were adopted in the late 1980s and early 1990s.
• Medicaid per diem rates increased faster than inflation but slower than overall health costs.
• Despite trends, national Medicaid reimbursement policies and rates exhibit significant diversity.

Conclusions:

• State Medicaid nursing facility reimbursement has undergone substantial methodological changes.
• The repeal of the Boren Amendment presents opportunities for state cost controls.
• Significant national variation in Medicaid reimbursement policies and rates persists.