Skip Navigation U.S. Department of Health and Human Services
Agency for Healthcare Research Quality
Archive print banner

Patient Safety/Quality

This information is for reference purposes only. It was current when produced and may now be outdated. Archive material is no longer maintained, and some links may not work. Persons with disabilities having difficulty accessing this information should contact us at: Let us know the nature of the problem, the Web address of what you want, and your contact information.

Please go to for current information.

Nursing home quality of care may suffer if budget shortfalls force States to freeze or reduce Medicaid rates

Medicaid is the dominant payer for U.S. nursing home services, accounting for roughly half of all nursing home spending. When surveyed in 2003, Medicaid directors in 19 States indicated their States were planning cuts in Medicaid spending for long-term care. If budget shortfalls force State legislatures to freeze or reduce Medicaid rates, quality of nursing home care may suffer, according to findings from a study supported in part by the Agency for Healthcare Research and Quality (HS11702). The study found that higher Medicaid payment was associated with a lower incidence of pressure ulcers (bed sores) and physical restraints, which are problems associated with poor quality of care.

Researchers led by David C. Grabowski, Ph.D., of Harvard University, examined the relationship between Medicaid payment and three nursing home quality measures—pain, high-risk pressure ulcers, and use of physical restraints—for a cross-section of certified U.S. nursing homes. After adjusting for market and selected nursing home factors, nursing homes in the highest Medicaid payment quartile had significantly lower prevalence than those in the lowest payment quartile of physical restraints (8 vs. 12 percent) and high-risk pressure ulcers (14.8 vs. 16.1), but they had significantly higher rates of pain (13.4 vs. 11.1). Higher resident pain rates among facilities with more resources may be due to the facilities using these resources to improve documentation of pain, an often neglected domain of quality, note the researchers.

See "Medicaid payment and risk-adjusted nursing home quality measures," by Dr. Grabowski, Joseph J. Angelelli, Ph.D., and Vincent Mor, Ph.D., in the September 2004 Health Affairs 23(5), pp. 243-252.

Editor's Note: For more information from this study, see the companion paper published previously by Drs. Grabowski and Agnelli: "The relationship of Medicaid payment rates, bed constraint policies, and risk-adjusted pressure ulcers," in the August 2004 issue of Health Services Research 39(4, Part I), pp. 793-812.

Another AHRQ-supported study on a related topic found that individuals eligible for both Medicaid and Medicare (dual eligibles) have lower hospital discharge rates and shorter stays than dual eligibles in traditional Medicare programs. For more details, see Sloss, E.M., Dhanani, N., O'Leary, J.F., and others (2004, December). "Inpatient utilization by dual Medicare-Medicaid eligibles in Medicare risk HMOs and fee for service, California, 1991-1996." (AHRQ grant HS10256). Managed Care Interface, pp. 30-34, 41.

Return to Contents
Proceed to Next Article

The information on this page is archived and provided for reference purposes only.


AHRQ Advancing Excellence in Health Care