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 Medicaid Information Clearinghouse

 
​Access key Medicaid information for your state.
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 Medicaid Shortfall Reports

 
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2013 Medicaid Shortfalls Report

medicaid_shortfall_graphic for web.jpgAHCA commissioned Eljay, LLC, to compile a report on Medicaid repayments to nursing home center 
providers. The annual study, 
A Report on Shortfalls in Medicaid Funding for Nursing Center Care, estimates the nation’s highest Medicaid shortfall on record – over $7.7 billion in 2013. On a daily basis, this shortfall is $24.26 per patient, which is 8.6 percent higher than the 2012 shortfall, at $22.34.

Read the press release​.

​​

Highlights of the report include:

  • The 2013 Medicaid shortfall is expected to exceed $7.7 billion nationally.

  • The estimated average Medicaid shortfall for 2013 of $24.26 per Medicaid patient day is 8.6 percent higher than the preceding year’s projected shortfall of $22.34.

  • For a typical 100-bed facility in which 63 percent of residents rely on Medicaid for coverage, this shortfall would mean a loss of more than $550,000 annually.

  • On average, Medicaid reimbursed nursing center providers only 88.3 percent of their projected allowable costs incurred on behalf of Medicaid patients. This means that for every dollar of allowable cost incurred for a Medicaid patient in 2013, Medicaid programs reimbursed, on average, approximately 88 cents.

  • Between the time periods covered by the cost reports used in the study and 2013, this study projects costs will increase an average of 3.8 percent, while rates increased an average of 2.9 percent.
To view state-by-state data, explore the Medicaid Shortfalls Database below. 

​​​​​​​​​​​

 

 Select State(s) to Filter Data

 
State:
Clear Selection
 

 2011 and Projected 2013 Shortfall

 
  
  
  
  
  
Arizona
($20.84)
($53,791,580)
($12.57)
($31,172,393)
California
($14.48)
($361,229,211)
($19.54)
($485,905,164)
Colorado
($7.87)
($27,448,063)
($7.86)
($27,482,593)
Connecticut
($19.65)
($124,661,630)
($25.43)
($153,289,453)
Delaware
($25.60)
($22,575,473)
($5.14)
($4,683,217)
Florida
($14.42)
($221,654,397)
($13.34)
($205,673,259)
Georgia
($11.78)
($105,952,420)
($9.71)
($85,833,996)
Hawaii
($14.41)
($13,526,894)
($6.69)
($5,943,376)
Illinois
($25.17)
($430,744,752)
($34.88)
($580,345,997)
Iowa
($12.10)
($52,257,853)
($11.56)
($49,289,254)
Kansas
($11.58)
($43,298,190)
($12.45)
($46,406,799)
Maine
($19.29)
($29,754,431)
($22.14)
($34,151,915)
Maryland
($14.40)
($79,371,825)
($13.31)
($72,954,038)
Massachusetts
($30.43)
($297,705,979)
($36.96)
($353,357,668)
Michigan
$0.59
$5,277,280
$4.47
$39,869,273
Minnesota
($29.35)
($168,705,012)
($34.44)
($186,002,509)
Missouri
($20.80)
($175,243,243)
($15.29)
($130,260,802)
Montana
($11.90)
($11,506,285)
($9.62)
($9,303,460)
Nebraska
($23.35)
($56,254,157)
($25.17)
($58,410,893)
Nevada
($17.11)
($16,113,385)
($16.40)
($16,111,880)
New Jersey
($40.12)
($415,670,131)
($47.05)
($487,606,379)
New Mexico
($22.61)
($30,412,478)
($12.15)
($15,921,737)
New York
($44.23)
($1,235,615,472)
($51.96)
($1,439,237,314)
North Dakota
($4.77)
($5,178,959)
($0.92)
($987,604)
Ohio
($15.89)
($288,460,410)
($17.79)
($316,764,966)
Oklahoma
($17.64)
($82,372,431)
($11.94)
($56,017,568)
Oregon
($12.21)
($20,222,206)
($18.14)
($28,707,396)
Pennsylvania
($22.34)
($409,549,935)
($25.92)
($470,506,209)
South Dakota
($28.54)
($36,478,782)
($35.40)
($43,716,809)
Texas
($16.05)
($340,314,264)
($16.32)
($352,512,188)
Utah
($24.86)
($25,959,847)
($19.45)
($20,402,934)
Vermont
($19.03)
($12,396,143)
($17.89)
($11,526,443)
Virginia
($10.46)
($65,545,985)
($9.93)
($61,811,119)
Washington
($28.02)
($109,226,802)
($33.88)
($128,769,998)
Wisconsin
($40.53)
($261,818,767)
($41.54)
($256,132,756)
Wyoming
($18.68)
($9,955,156)
($5.25)
($2,643,556)

NOTES:

The significant reduction in shortfalls between 2011 and 2013 in Arizona, Delaware, Hawaii, and Wyoming is due to the implementation of provider tax programs in these states between 2011 and 2013.

Rates for New Mexico are estimated since managed care organizations would not provide provider-specific rates. They are based upon those in effect prior to the program shift to managed care and increased by legislative-mandated rate increases.

In projecting the FY 13 shortfall for Michigan, as with other states, costs were projected to increase by market basket. However, over the past 4 years, costs in Michigan have historically increased by an average of 2.7 percent annually. If this historical inflation average were applied rather than market basket, the projected margin in Michigan drops to $1.36.

* ​Daily - Shortfall Per Medicaid Patient Day​​
.