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 Nation’s Poorest Teetering On Edge Of $7.7 Billion Medicaid Gap, Report Finds

The gap between the costs of care for residents in the nation’s skilled nursing centers and what states are paying for that care has grown to $7.7 billion, a new study finds.

The average state pays about 88 cents in care reimbursements for every dollar allowed under Medicaid laws, the authors of “A Report on Shortfall in Medicaid Funding for Nursing Center Care” say.

Between 2011 and 2013, the costs to care for the nation’s poorest long term care residents rose by 3.8 percent on average, while state reimbursement rates grew by 2.9 percent, the study says.

The study was conducted by research firm Eljay and was commissioned by the American Health Care Association (AHCA).

Long term care advocates say Eljay’s findings are alarming.

“At a time when Affordable Care Act reforms are fundamentally changing the Medicaid program and the way care is delivered, this report raises a number of challenges facing the nursing center profession," AHCA President and Chief Executive Officer Mark Parkinson says. “With a low operating margin as reported by MedPAC, our profession does not need more cuts to Medicaid.”

Among its other results, Tuesday’s report found that the average Medicaid patient in 2013 was being shortchanged about $24 per day, an 8.6 percent wider gap than 2012’s $22 per day. For a 100-bed nursing center, where 63 percent of residents rely on Medicaid (a typical business, in other words), the gap means more than $550,000 in losses per year, Eljay said.

And that’s just on the macro level. Digging, Eljay shows that the states with the 10 biggest coverage gaps in 2013 were:
1.) New York, with more than $1.4 billion
2.) Illinois, with more than $580 million
3.) New Jersey, at nearly $488 million
4.) California, at nearly $485 million
5.) Pennsylvania, at almost $471 million
6.) Massachusetts, at more than $353 million
7.) Texas, with nearly $353 million
8.) Ohio, at almost $317 billion
9.) Wisconsin, at $256 million; and
10.) Florida, at nearly $206 million

Even when adjusting for states’ populations, New York continued to lead the nation with the biggest daily gap, at nearly $52 per resident. It was followed by New Jersey (about $47 per day), Wisconsin (almost $42 per day), Massachusetts (almost $37 per day), South Dakota and Illinois (about $35 per day), Minnesota and Washington (about $34 per day) , Pennsylvania (nearly $26 per day), and Connecticut (more than $25 per day), Eljay found.

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