Medicaid Underfunding



 
 
Staffing and Quality Within Nursing Homes
 
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Illinois’ Medicaid Nursing Home rates are underfunded by approximately $400 million. This burden is the single greatest challenge to the nursing home profession especially in light of the COVID-19 pandemic. Reforming the Medicaid payment system is necessary in order to provide the needed funds to promote quality and accountability. Current inequities and negative incentives within the system show reform is needed TODAY.  
  • Nursing home Medicaid rates should be tied to the actual direct care staffing within a facility based on the resident’s needs.
 
  • Legislators should work to develop a nursing home Medicaid rate system to achieve improved outcomes and increased accountability with an emphasis on patient-centered care.
 
  • Rates must reward and incentivize quality - both rewarding those who are quality providers and incentivizing improvements in quality. Accountability, clarity, and transparency must be a part of this system.
  • Data has shown that nursing facilities with the lowest staffing hours per resident day currently benefit the most under the Medicaid rate system and have the best health care cost coverage.
 
  • A nursing home Medicaid rate redesign must include quality driven components such as consistent direct care staffing and staff retention that incentivizes staffing in a manner that provides accountability and transparency.
 

 
An Illinois statewide survey found that 81% of the respondents agreed funding for long-term care and assisted living centers should focus on improving staffing, quality initiatives, and resident outcomes.
 
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