hand placing Medicaid puzzle piece

A new analysis from the nation’s largest nursing home trade group finds that facilities taking care of a larger proportion of Medicaid beneficiaries have lower quality ratings.

The American Health Care Association presented those preliminary results earlier this month at the National Health Policy Conference in Washington, D.C. Based on a sample of more than 13,600 SNFs, they found that Medicaid census and quality are inversely related.

While the results are not a surprise to the industry, Marsida Domi, AHCA’s senior research analyst, said it strengthens AHCA’s position on pushing for better Medicaid reimbursement.

“Numerous studies have shown that Medicaid underpays for services,” Domi told McKnight’s in an email. “State Medicaid agencies need to develop a payment system that recognizes facilities with a high percentage of Medicaid beneficiaries to help achieve the same quality levels as facilities with a lower percentage of Medicaid beneficiaries.”

SNFs included in the sample were non-hospital based, with 25 beds or more that were Medicare or Medicaid certified between 2015 and 2017.

On average, for-profit nursing facilities took care of a significantly higher percentage of Medicaid beneficiaries (62.5%) when compared to their nonprofit counterparts.

Rural facilities have slightly more than urban SNFs, which the AHCA highlighted in a recent blog post. Large facilities with more than 120 beds also had more Medicaid patients that smaller facilities with fewer than 50 beds (64.5% vs. 45.9%).

AHCA said it is now working on expanding the study to better understand the relationship between Medicaid census and quality.

“The next step is to look at how much of an increase in the Medicaid reimbursement rate is necessary so that the same levels of quality can be achieved no matter how many Medicaid beneficiaries there are in a skilled nursing facility,” Domi told McKnight’s.