Washington, D.C. — For the first time, researchers have developed a reliable, publicly available method to compare how much each state pays nursing homes per Medicaid patient day — and what they found highlights just how wide the gap between states can be.
A new study published in Health Services Research introduces a standardized approach to estimating state-level Medicaid nursing home payment rates using data the federal government already makes public. Until now, researchers who wanted to compare Medicaid reimbursement across states had to rely on restricted or proprietary datasets — a significant barrier to understanding how payment differences affect care quality and access.
The methodology, developed by researchers including H.C. Ratliff and colleagues, works by dividing total Medicaid nursing home spending in each state by the total number of Medicaid patient days in nursing homes. The team drew on publicly available data from the CMS-64 report — which tracks state Medicaid expenditures by service category, including both base payments and supplemental payments — as well as data from CMS and Brown University’s LTCFocus database to validate their estimates.
“The strong correlations between the new measure and historical estimates support its validity as a research tool,” the authors said. The method, they noted, “facilitates timely cross-state comparisons of Medicaid payment rates without the need for restricted or proprietary data.”
Why this matters for operators
Medicaid reimbursement is the financial backbone of most skilled nursing facilities. But how much states actually pay per Medicaid day varies significantly — and that variation has direct consequences. Facilities in states with lower reimbursement rates often struggle to cover staffing costs, meaning residents can end up with fewer care hours. In some markets, operators have quietly stopped accepting Medicaid patients altogether, a trend linked to low payment rates that compounds access problems for hospitals and families trying to discharge patients to post-acute care.
The ability to compare payment rates across states in real time — and with publicly available data — could change how advocates, researchers, and policymakers make the case for rate increases. Right now, that kind of comparison is slow and often requires access to data that most researchers and advocacy groups don’t have.
A tool, not just a study
Researchers analyzed publicly available data from Medicaid expenditure reports covering multiple fiscal years and cross-referenced the results against LTCFocus historical estimates to confirm accuracy. The validated approach is designed to be replicable and updatable — meaning it can track how payment rates shift over time as states adjust their Medicaid programs.
That timeliness is increasingly relevant. With federal Medicaid cuts looming and states already making preemptive reductions to their programs, nursing home operators need clarity on where reimbursement stands before they can plan staffing levels, capital investments, or admissions policies.
The study was published in Health Services Research, a peer-reviewed journal covering health policy and services research. The methodology data were drawn from publicly available CMS expenditure reports and state-level nursing home utilization data.
