State-imposed limits on Medicaid reimbursement for nursing facility care

Abstract

Objectives: Nursing cost-center limits were examined, along with their effects on Medicaid.

Methods: A national survey of Medicaid nursing facility reimbursement provided data on cost centers for nursing, administration, and capital, whether in specific, larger, or multiple cost centers.

Results: Most states impose nursing and administration limits. Far fewer states impose capital limits, but only capital limits may be related to constraint of reimbursement rates.

Conclusions: Shifting toward limiting capital costs, or simply eliminating cost-center limits, might accommodate cost control while removing negative constraints on direct resident care.