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Medicaid Shortfalls

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.

  • 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. 



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