Nursing Homes:

Admission Problems for Medicaid Recipients and Attempts to Solve Them

HRD-90-135: Published: Sep 5, 1990. Publicly Released: Sep 5, 1990.

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Pursuant to a congressional request, GAO assessed problems Medicaid recipients faced when trying to gain admission into nursing homes, focusing on: (1) the types of reforms that various states implemented to improve Medicaid recipients' access; and (2) factors that influenced states' willingness to improve access for Medicaid recipients.

GAO found that: (1) in nine states, some Medicaid recipients had more problems getting into nursing homes than comparable private payers; (2) there were no generally accepted measures of access, but some states described nursing home access problems by the length of time it took to gain admission to a nursing home; (3) accessibility problems resulted in increased health care costs, and in one state, waiting time for an available bed increased 55 percent in 1 year, raising the cost of care for those days from $5.7 million to $10.5 million; (4) one state required that Medicaid and private-pay rates be equal, which improved Medicaid recipients' access by removing the financial incentive nursing homes had to select private payers; (5) in a number of states, increasing Medicaid rates or changing the payment systems improved access for Medicaid recipients; (6) one state reported that implementation of a payment system based on care needs improved accessibility for Medicaid recipients requiring extensive care; (7) for financial reasons, states may not be willing to voluntarily improve Medicaid recipients' access to nursing homes through payment reforms or other measures; and (8) regulatory reforms that remove the source of payment as a criterion for admission could improve Medicaid recipients' access, but some officials considered such regulatory reforms inappropriate and ineffective and there was little data available to evaluate the effectiveness of such reforms.

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