While many states have increased provider taxes since 2008, many also raised payment rates for skilled nursing facilities, according to a three-year study from the General Accountability Office.

Results of the survey, conducted between 2008 and 2011, provide insight in preparation to more people being added to the Medicaid rolls in 2014, per the Affordable Care Act.

Almost all of the provider taxes that were increased were on institutional providers, including skilled nursing facilities. States said this was to avoid cuts in service or payment rates. Within three years, the number of states implementing new or increasing existing provider taxes more than doubled, from 12 to 26. By last year, only a handful of states reported decreasing their provider tax.

However, states reported increasing payment rates to SNFs more than any other provider type. In 2011, 19 states reported an increase in rates, the GAO report says.

Finding healthcare providers to handle the number of beneficiaries remains a problem. States have said low Medicaid payment rates pose a particular challenge in finding specialists in the areas of dentistry, psychiatry, obstetrics/gynecology, and pediatrics.

Other highlights of the report: Most states reduced their time investment in Medicaid application processing, and less than 4% of Medicaid users reportedproblems getting medical care or prescription drugs (which compares to privately insured people).

The GAO report was released Nov. 15 and can be seen here.