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New Medicaid Study Finds Payment Gap Between Seniors’ Actual Care Cost and Provider Reimbursement Most Problematic in NY, IL, OH, TX, NJ, PA, MA, FL, CA, WI  
New Medicaid Study Finds Payment Gap Between Seniors’ Actual Care Cost and Provider Reimbursement Most Problematic in NY, IL, OH, TX, NJ, PA, MA, FL, CA, WI
States With Largest Patient Per Day (PPD) Funding Differential: WI, NJ, MA, NY, WY, IL, MN, MO, NE, RI

Katherine Lehman
(202) 898-2816

Washington, DC – A new Eljay LLC analysis of the nation’s Medicaid financing system projecting states will cumulatively under fund the actual cost of providing quality long term care by nearly $4.7 billion for 2009, and finds seniors in the states of New York, Illinois, Ohio, Texas, New Jersey, Pennsylvania, Massachusetts, Florida, California and Wisconsin will bear the brunt of the under funding burden at a time when these states and many others are already suffering from rising pressure on state Medicaid budgets.

New York, Illinois, New Jersey, Massachusetts and Wisconsin facilities and the seniors under their care unfortunately fall under both “Top Ten” lists below in terms of highest aggregate Medicaid underfunding and highest per patient per day underfunding.

“Yesterday, we outlined how and why the cumulative $4.7 billion Medicaid under funding is significant to the federal health care reform debate,” said Robert Van Dyk, Chair of the American Health Care Association (AHCA). “Today we are focusing needed attention on which states’ seniors suffer from the largest state Medicaid funding gaps at a time of deteriorating budget conditions, and worsening fiscal crises in state capitols across America.”  

States with largest aggregate Medicaid underfunding (in millions):

States with largest Medicaid per patient day underfunding:

1.      New York          $688.3

1.      Wisconsin          $28.41

2.      Illinois                $359.6

2.      New Jersey       $25.13

3.      Ohio                    $306.1

3.      Massachusetts  $24.95

4.      Texas                  $271.1

4.      New York          $24.10

5.      New Jersey       $264.2

5.      Wyoming             $23.06

6.      Pennsylvania        $254

6.      Illinois                $20.80

7.      Massachusetts  $251.4

7.      Minnesota           $20.31

8.      Florida                $235.1

8.      Missouri              $19.15

9.      California             $219.6

9.      Nebraska            $19.09

10.    Wisconsin          $201.4

10.    Rhode Island       $18.80



“The substantial gap between the cost of providing quality care to seniors and what Medicaid actually pays – combined with the enormous pressure on state budgets caused by the ongoing recession – represents a clear and present danger to America’s most vulnerable frail, elderly and disabled citizens,” warned Van Dyk. “With our national and state economies in an historic cyclical downturn, this state data serves as a stark reminder of the vital importance to evaluate both Medicare and Medicaid funding as a final federal health care reform bill takes shape. At stake is seniors’ ongoing access to quality care, sustaining a strong long term care workforce and local jobs base, and the very ability of our sector to remain strong in the face of challenging demographic realities.”

The American Health Care Association and National Center for Assisted Living (AHCA/NCAL) represent more than 13,000 non-profit and proprietary skilled nursing centers, assisted living communities, sub-acute centers and homes for individuals with intellectual and developmental disabilities. By delivering solutions for quality care, AHCA/NCAL aims to improve the lives of the millions of frail, elderly and individuals with disabilities who receive long term or post-acute care in our member facilities each day. For more information, please visit or