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Estimating the Nursing Home Medicaid Rate

As LeadingAge NY notified members in our memo on the Governor’s 30-day State budget amendments last week, one of the amendments clarifies a budget proposal on how the nursing home Medicaid case mix freeze would be applied. Members will recall that in the summer of 2023, the Department of Health (DOH) announced its intent to freeze Medicaid case mix once data to make these adjustments were no longer available due to federal changes. Data are available to make case mix updates to the January 2024 rates, which is the case mix that the State intended to freeze until a new acuity adjustment methodology could be developed and implemented. The new methodology is expected to be based on the Patient-Driven Payment Model (PDPM), which is used in Medicare reimbursement.

In contrast to the originally announced plan, the 30-day amendments clarify that the State budget proposes to base the freeze on the case mix reflected in the July 2023 Medicaid rates (i.e., using data from October 2022 through March 2023 Minimum Data Set (MDS) assessments), rather than the newer case mix in the January 2024 rates. Note that this is part of the proposed Executive Budget subject to finalization through negotiations with the Legislature.

To assist members in assessing the financial impact of this proposed change, we have adapted the Medicaid rate template to specifically calculate the direct component based on user-entered case mix information. Users can estimate annual impact by entering the count of their annual Medicaid days. Click here to download the template. We welcome members to share their projected impact with us by email to edumas@leadingageny.org.

Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841