A lack of consistency in how the Centers for Medicare and Medicaid Services (CMS) reimburses programs serving special needs plan (SNP) populations is getting in the way of improving outcomes and reducing hospitalizations, according to providers, payers and consultants in the nursing home sector. Today’s institutional beneficiary is usually eligible for models with similar clinical […]
Nursing home operators are getting a clearer picture of the Medicaid-rate environment – modest increases for most, while other states are seeing no change. Eleven states have reported their Medicaid rate cycle turnover since July 1, with West Virginia seeing the highest median rate increase of 3.3%, followed by Indiana with a 2.5% increase and […]
Nursing homes may be impacted by a health insurer’s decision to cut benefits for 3,500 low-income seniors in California, with the latest extensions for the program going through Dec. 31. Health Net has announced a cut to assisted living benefits in the state, and leaders in the post-acute sector believe this may lead to resident […]
Mounting financial pressures among both Medicaid and Medicare payers, fragmented health care settings, and the growing use of value-based care as a cost-cutting measure are creating unique challenges and opportunities for nursing homes serving dual-eligible beneficiaries. Maintaining and evolving such plans will depend on how adept nursing homes are at providing strong data to demonstrate […]
The U.S. Department of Health and Human Services (HHS) and Centers for Medicare and Medicaid Services (CMS) on Tuesday deferred more than $1 billion in federal Medicaid payments to California and Minnesota. The agencies plan to expand this deferment tool in the future. That’s approximately $867.5 million in deferred federal payments to California, and $199 million […]
Colorado nursing homes are seeing higher citations and resident complaints as state regulators weigh changes to minimum staffing standards for nursing homes. The number of formal complaints from SNF residents in Colorado continued to climb, reaching 7,426 during the 2025 fiscal year across the state’s nursing homes and assisted living communities, a story in the […]
Managed Medicaid hasn’t always worked well for nursing home providers, with some states modifying or scrapping their programs due to payment lags and higher costs – the latest casualty being Indiana’s program. And yet, managed Medicaid is expected to spread across the nation. Lessons from failed experiments with Indiana – and experience with problems in […]
The skilled nursing sector entered 2026 in a different environment than it faced a year ago, one rife with opportunities to expand its footprint and service lines, as well as redefine its business model. While operators continue to face reimbursement pressure, managed care complexity and workforce challenges, they have also been able to move away […]
The Ohio state legislature corrected millions in Medicaid underpayments this week, approving $875 million in quality incentive payments (QIPs) to be sent to nursing homes in the state. Legislation stipulates that nursing homes who accept the money waive future legal claims related to the disputed formula. The payout is coupled with a budget correction measure […]
The total number of nursing homes fell by 6% between 2015 and 2025, from 15,643 to 14,742, with half of that decline occurring in rural areas. That’s according to an analysis published in KFF Health News, which also took a closer look at the rural nursing home financial landscape, noting that the 2025 federal reconciliation […]
Some nursing home operators in New Hampshire are facing Medicaid cuts due to a disconnect between old payment methodology and a newer one, spurring legislative action. The discrepancy stems from a formula that relies on case mix index measuring patient needs on a specific date. This figure is compared against an overall patient mix that […]
After years of workforce instability, skilled nursing operators are finally seeing signs of progress in staffing – yet new policy developments and ongoing state level mandates threaten to complicate that recovery in 2026. Sector leaders say declining agency use, stronger hiring pipelines, and expanded training programs helped stabilize staffing in 2025. However, regulatory pressures – […]
Low Medicaid reimbursement rates are making it increasingly difficult for hospitals to transfer patients to nursing homes because of beds that are offline. As state Medicaid payments fail to keep pace with rising costs, many skilled nursing facilities are becoming more selective – limiting the number of Medicaid patients they accept and instead prioritizing higher-paying […]
Rather than raising Medicaid rates, New York may simply add a $1.5 billion health care funding increase – but split between hospitals and nursing homes. Operators in the state are concerned with this decision, since it’s unclear how those funds would be broken down. But, nursing homes said they’d need at least half. As budget […]
Nursing homes in Ohio are navigating uncertainty from two directions: the ongoing saga of overdue quality incentive payments (QIPs) and longer-term reimbursement changes included in state legislation. These issues come at a time when providers are caring for residents with higher acuity and complex needs, while also working to invest in quality care and workforce […]
Nursing home operators, as always, are juggling many moving parts to stay ahead, but some initiatives are taking precedence this year – particularly stabilizing the workforce via career ladders, policy changes tied to Medicaid and managing technology. Executives are discussing policy and reimbursement hurdles, with the One Big Beautiful Bill Act (OBBBA) spurring talks with […]
A national study of state-level nursing home staffing mandates, which found that higher direct care staffing requirements did not hurt finances or increase facility closures, is receiving pushback from advocates. The lead researcher, however, says federal or expanded state mandates would likely not harm nursing homes. Rachel Werner, lead researcher of the study, acknowledged limitations […]
Nursing home operators are considering operational adjustments and, in some cases, calling for redoubled advocacy efforts as states enter state budget discussions. In several states, Medicaid reimbursement changes are already underway amid ongoing financial pressures and the provisions of the 2025 reconciliation law, fueling concerns. For most states, budgets will be adopted by June 2026 […]
A New Jersey bill aimed at strengthening financial protections for nursing home residents at admission could affect how facilities enroll new residents and handle Medicaid applications, potentially increasing administrative burdens and causing admission delays. The proposal would require the New Jersey Department of Health (NJDOH) to create standardized admission contracts for nursing homes and assisted […]
Higher Medicaid payment rates are associated with a greater likelihood of receiving 4- or 5-star Care Compare ratings, according to a new study published in the Journal of the American Medical Directors Association (JAMDA). In the cross-sectional study published last week, researchers used 2019 data from 9,473 freestanding nursing homes across 44 states to analyze […]
