Medicaid Nursing Facility Payment Policy

Download Publication (pdf)

April 2016

State Medicaid programs are required to cover nursing facility services, which are services provided by a Medicaid certified institution that offers 24-hour medical and skilled nursing care, rehabilitation, or health-related services to individuals who do not require hospital care. Medicaid is the primary payer of nursing facility services for about 63 percent of nursing facility residents nationally.

States have broad flexibility to determine payments to nursing facilities. MACPAC has documented each state’s fee-for-service (FFS) nursing facility payment policy, including how individual states set their payment rates and various adjustments and supplemental payments, in State Medicaid Fee-for-Service Nursing Facility Payment Policies.

Publication Type: Issue Briefs

Tags: behavioral health, cost-based reimbursement, fee for service, long-term services and supports, nursing facilities, payment, supplemental payments, Upper Payment Limit (UPL)