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The gap between allowable Medicaid costs and actual state payments is projected to hit $4.5 billion this year, an industry-backed study has found.

The average per diem gap in Medicaid reimbursement will be $13.10, according to an analysis by BDO Seidman. Joe Lubarsky, who conducts the study each year, said that more states are directing funds to non-institutional settings. He added that Medicare is continuing to cross-subsidize the gap.

Lubarsky added that changes to Medicaid asset transfer rules in the Deficit Reduction Act of 2006 could exacerbate the problem. The full report is available at www.ahca.org.