Modifying the Case-Mix Medicaid Nursing Home System to Encourage Quality, Access and Efficiency

Posted on: 2010-10-01 00:00:06

With funding from the New York Community Trust, LTCCC undertook a study on case-mix reimbursement, the system of paying for nursing home care utilized by the majority of states, to identify and assess how each of these systems is structured and the impact of that structure on: quality of care, access to care for individuals with higher needs and the efficiency in the use of public funds. Project goals were to: (1) identify how states can modify their nursing home case-mix reimbursement systems to better encourage quality care, access and efficiency; (2) relate nursing home reimbursement to inspection and enforcement; (3) relate nursing home reimbursement to quality outcomes; and (4) respond to the specific budget proposals in our home state, New York State, as the it identifies, assesses and implements ways to modify its reimbursement system, so that it better achieves the goals of quality and efficiency in the face of the current economic crisis. In order to accomplish these goals, LTCCC: gathered detailed information on the characteristics of each of the 35 states using a case-mix nursing home Medicaid reimbursement system; surveyed state ombudsmen and representatives of citizen advocacy groups; selected seven states for in-depth analysis as case studies; and interviewed state officials from these seven states. All this information is detailed in the final report with specific recommendations for change.

Click on the buttons below to download free copies of the relevant documents.

Full Report - New York Edition

Full Report - National Edition

Executive Summary

Media Alert - March 2009

For earlier studies on case-mix click on the titles:

Case-Mix Reimbursement and RUGs: What Consumers Should Know

Modifying RUGs: Responding to Consumer Concerns in New York State,

and Case-Mix Reimbursement and the Nursing Home Resident in NYS.

LTCCC's Executive Director and Director of Special Projects Trains Advocates: How to Modify the Case-Mix Medicaid System in Their State

On October 23, 2009, Richard Mollot and Cynthia Rudder presented at the NCCNHR Annual Conference in Washington, DC. Their presentation consisted of an introduction to nursing home Medicaid reimbursement, why understanding reimbursement is crucial for advocates, findings and recommendations from the LTCCC study and ways in which advocates can make changes in their own state.

Click Here to Download Presentation

For information on Consumer Participation In Nursing Home Medicaid Reimbursement Policy Making go to

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