![]() KHN’s coverage of end-of-life and serious illness issues is supported by The Gordon and Betty Moore Foundation and its coverage related to aging & improving care of older adults is supported by The John A. Iowa is the only state where Medicaid does not cover a majority of nursing home residents. In Alaska, 83 percent of nursing home residents are covered by Medicaid. This final chart shows, by state, the percentage of nursing home residents who rely on Medicaid. If I’m a nursing home and I can barely afford my patients, I’m going to send my patients to the hospital.” “When Medicaid nursing homes are poor and perform poorly, their hospitalization rate increases, and Medicare pays for those hospitalizations. Mor said the Medicaid cuts might not even save the government money in the end. Those that can’t will try to keep their beds as full as possible and live with a negative margin and reduce food, reduce staff and try to struggle along.” “Nursing homes that can will get out of the Medicaid business if it’s at all possible. ![]() “It’s very likely that if Medicaid payment rates freeze or decline, there would be adverse effects,” said Vincent Mor, a professor at the Brown University School of Public Health. Facilities with the best inspection records (five star) have an average 47 percent of residents on Medicaid. At nursing homes with worst inspection records (one star), an average 65 percent of residents are on Medicaid. The third chart, below, shows how homes with more health violations usually also have more Medicaid beds. State inspectors give citations to homes that don’t protect residents from bed sores, accidents, infections and other types of harm. The government publishes a third set of stars representing the results of health inspections. ![]() A home’s ability to buy medical equipment, medications and oxygen and to keep the building operating can also suffer. David Gifford, senior vice president for quality and regulatory affairs at the American Health Care Association, a nursing home trade group. Low staffing is just one factor behind inferior quality ratings for homes that rely heavily on Medicaid, said Dr. At the worst-staffed homes (one star), 7 of 10 residents are on Medicaid. At the best-staffed homes (five stars), only 4 of 10 residents are on Medicaid, meaning the remainder of residents are more lucrative for those facilities. As the chart below shows, the staffing differences are huge: The average five-star home has enough nurses and aides to provide 5.4 hours of care a day for each resident while the average one-star home provides 3.0 hours of daily care per resident. Medicare assigns a second type of star rating representing staffing levels and based on the ratio of nurses to residents. One-star homes (lowest quality) average 69 percent of residents on Medicaid Five-star (highest quality) average 49 percent of residents on Medicaid.Ī prime reason for the disparity, researchers have found, is that nursing homes with the most Medicaid residents can’t afford as many nurses and aides. The chart below shows the big picture: Nursing homes with higher percentages of residents covered by Medicaid earn fewer stars on the federal government’s overall quality rating system. Factors weighed: how well each facility performs on government inspections, how many nurses and aides it employs, and how healthy its residents are as judged by such measures as how often they fall, get infections or are admitted to the hospital. The government rates nursing homes on a scale from one to five stars, based on overall quality. These four charts, based on a Kaiser Health News analysis of ratings from the federal government’s Nursing Home Compare website, show how care suffers in nursing homes where Medicaid is the dominant payer for residents. And the quality of care, experts say, would deteriorate further. If the feared reductions come to fruition, states would likely respond by either lowering their payment rates or restricting whom they cover and for how long. ![]() It can be republished for free ( details). ![]()
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