National Study Confirms Medicaid Payments Fall Short of Costs, Shows Links to Staffing Levels and Ownership

A new study on Medicaid payment rates from 44 states shows Medicaid payment rates among nursing homes on average don’t adequately cover today’s costs. Meanwhile, higher staffing levels often correlate with lower Medicaid payment-to-cost ratios. And, nonprofits appear to have the lowest payment-to-cost ratio for Medicaid. Medicaid rates only covered bout 82 cents per every […]

Transition to Managed Medicaid Causing Chain Reaction of Challenges, as Nursing Homes Also Contend With Redetermination

Multiple states have been working toward a transition to managed Medicaid from the traditional state-run program, but there have been concerns about reimbursement timing and insufficient payment amounts due to the change. And that’s just the first layer of challenges. Payment portals unique to each managed Medicaid contractor is another hurdle to overcome, in addition […]

Democratic VP Pick Walz, State Legislature Release Second Round of Nursing Home Financial Aid in Minnesota

More state grant funds are being distributed to nursing homes in Minnesota, as part of a $173.5 million initiative. In 2023, Minnesota Governor Tim Walz, who is also the Democratic vice presidential nominee, and the state legislature, signed off on a $300 million bipartisan package to address the crisis facing nursing homes across the state. […]

How Nursing Home Providers Can Optimize Reimbursement Under PDPM-Based Medicaid Models

As the Medicaid payment system transitions across states from RUGS to the Patient-Driven Payment Model (PDPM), nursing home operators must be wary of misconceptions – including that the transitions will always lead to additional Medicaid funds being available – while putting in place the right practices to ensure appropriate payments. The complexities of Medicaid transitions […]

‘Tug of War’: Inside Navigating the Pitfalls of Dual Eligible Coverage in Nursing Homes

Delivering care to dual eligible nursing home residents can be complex with so many payers involved in the industry, but aligning incentives, quality measures and tools for providers can help operators serve this demographic. Dual eligible residents, or those that can receive benefits from both Medicare and Medicaid, often find themselves in a “tangled web […]

$29M Medicaid Rate Increase in State Heavily Focused on Direct Care

Oklahoma on Monday approved a nearly $29 million Medicaid funding increase for nursing homes attracting additional federal dollars to improve provider rates. It’s unclear if the rate increase would be enough to meet the upcoming federal minimum staffing standard. The Oklahoma Health Care Authority Board (OHCA) approved the increase after the 2024 legislature called on […]

CMS Entrenching ‘Old Covid Scars’ With Expansion of Civil Monetary Penalties, Starving Nursing Homes of Much-Needed Resources

Nursing home operators say the civil monetary penalty (CMP) expansion is proving to be one of the most problematic features of the 2025 Skilled Nursing Facility Prospective Payment System (SNF PPS) final rule. Initially, there was excitement for the Medicare payment increase, but this has turned to dread for operators who are already dealing with […]

Indiana Nursing Homes Struggle with Delayed Payments Under Managed Medicaid

In the wake of Indiana’s transition to managed care for Medicaid services on July 1st, nursing home operators across the state are grappling with significant financial uncertainties due to delayed reimbursements, leaving many small facilities struggling to make payroll for their employees. Jeff Huffman, chief operations officer of The Strategies, a family-owned long-term care organization […]

State Offers Medicaid Funding to Nursing Homes for Private Rooms

Nursing homes in Ohio will soon receive financial incentives for each additional private room they offer, thanks to a proposal recently greenlit by the Centers for Medicare & Medicaid Services (CMS). The initiative, set to launch in the coming months, was developed by the Ohio Department of Medicaid and revises the reimbursement structure for Medicaid-funded […]

‘Fighting for a Rate Floor’: Stagnant Medicare Advantage Rates Force Nursing Homes to Shift Payers

Operators have been opting for different payer sources other than Medicare Advantage plans given its persistent challenges. Medicare Advantage’s lower reimbursement rates compared to traditional Medicare and higher administrative burdens tied to prior authorizations and payment denials, have caused operators to seek even Medicaid as an alternative payer, emboldening efforts by advocacy groups to push […]

Nursing Home, CCRC Spending To Reach $337B by 2032, as Insurance Enrollment Reaches New Heights

Expenditures for Nursing facilities and continuing care retirement communities (CCRCs) is expected to reach $237.6 billion in 2026, and $337.4 billion by 2032, according to data released Wednesday. Nursing homes and CCRCs have been increasing steadily since 2021, states a report prepared by the Office of the Actuary (OACT) at the Centers for Medicare & […]

More Centers Health Care Nursing Home Facilities Involved in Medicaid Fraud Allegations

More nursing homes owned by Centers Health Care are being investigated for alleged Medicaid fraud, while also having been plagued with serious safety concerns. The 240-bed Hammonton Center and Deptford Center for Rehabilitation and Healthcare in New Jersey, join other facilities owned by Centers Health that are under investigation, according to a report from the […]

LTC100 Panelists Weigh in on CMS Staffing Rule’s ‘Bloodbath’, Growth Strategies, and Risk-Based Model Reimbursement

If there’s no additional funding for the minimum staffing rule, well over 5% of existing facilities will close, depending on how successfully operators can pivot to meet the standard. The rates of closure may even reach 10% to 15%, depending on the market, cautioned sector leaders attending the LTC100 conference this week. Steve Nee, CEO […]

Senate Hearing Focuses on Long-Term Care Worker Woes, But Provider Groups Say Related Bill ‘Misses the Mark’

Federal lawmakers have introduced the Long-Term Care Workforce Support Act, in conjunction with a hearing that took place Tuesday, hosted by the U.S. Senate Special Committee on Aging. The bill, if passed, would increase the number of direct care professionals, including in rural communities. Some associations representing the nursing home industry said the legislation managed […]

Even in States with Medicaid Increases, Nursing Home Closures Pile Up

Despite a 17.5% Medicaid increase last year, at least 25 nursing homes closed in Pennsylvania since the pandemic began – and a significant financial shortfall remains, leaders said. Closures equate to a loss of 2,588 certified nursing home beds in the state since 2020. The continued workforce shortage and underfunding of Medicaid made closures and […]