In 1999, Milan Basta, M.D., Ph.D., Potomac, Md., reviewed Medicaid nursing home reimbursement policies and their impact on palliative care. Because nearly 70 percent of nursing home residents depend on Medicaid to pay for their care, its policies affect the care that dying patients in nursing homes receive.

Basta reviewed Medicaid nursing home care benefits in the 50 states and the District of Columbia, assessed the impact of these benefits on care for dying nursing home residents and identified how Medicaid hospice benefits vary from state to state.

The project was part of the Robert Wood Johnson Foundation (RWJF) program, Targeted End-of-Life Projects Initiative.

Key Results: Basta submitted project results to RWJF in a report entitled A Review of Medicaid Nursing Home Policies and Their Impact on Care at the End of Life. The results included:

• Nearly 40 percent of people who reach age 65 will eventually spend time in a nursing home, but at present only 1 percent of nursing home residents receive Medicaid hospice benefits.
• Most states pay a pre-determined rate for a set of defined services, based upon the costs of the facility. About half of the states are experimenting with matching payment to the needs of nursing home residents.
• Medicaid pays for prescription drugs in only three states.
• Patients in nursing homes who are eligible for Medicaid and Medicare can receive hospice care in a nursing home through Medicare.
• Research does not necessarily support the argument that higher Medicaid reimbursement to nursing homes assures higher quality of services.

Key Conclusions:

• A strategy to improve nursing home care at the end of life must include training of staff.
• Public scrutiny of quality outcomes in nursing homes might promote accountability.