Medicaid nursing facility reimbursement methods: 1979-1997

This article describes state Medicaid nursing facility reimbursement method s and rates in 1979-1997, using data derived from telephone surveys of stat e Medicaid reimbursement. The 1980s saw shifts toward prospective methodolo gy The late 1980s and early 1990s were characterized by adoption of casemix methods. The early 1990s also saw fewer changes in methodology with a hiat us in the mid-1990s followed recently by renewed changes to methodology. Me dicaid per diem rates have increased faster than inflation but less rapidly than general health costs. The repeal of the Boren Amendment may now allow states to institute greater cost controls or moratoria on rate increases. Despite states' tendencies to follow one another's examples, Medicaid reimb ursement remains diverse nationally, with wide differences in policies and rates.