IS MEDICAID PAYMENT THE KEY TO RAISING - STAFFING LEVELS IN NURSING HOMES? INSIGHTS FROM A FACILITY LEVEL ANALYSIS

Sep 29, 2026

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Nursing home staffing levels correlate with care quality, yet facilities struggle to recruit and retain nurses because Medicaid—covering roughly two-thirds of residents—does not reimburse the full cost of care. Using Payroll-Based Journal data and state Medicaid payment rates, the study analyzes 9,513 freestanding nursing homes across 44 states in 2019, testing links between Medicaid rates and staffing across for-profit, not-for-profit, and government ownership types. Results show higher Medicaid rates align with higher staffing, with differing responses by ownership, suggesting policy can mitigate staffing shortages by increasing payment resources.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages1

Reading Time3 min

AccessFree to download

Study Background and Motivation

Data Sources and Population

Method and Ownership Comparisons

Findings and Policy Implications

Innovation in Aging, 2025, Vol. 9, No. S2 793 practical nurses, and nurse aides. Regression results accounted for facility/resident characteristics (e.g., case-mix) and state-fixed effects. Across all ownership types, higher Medicaid rates were associated with higher staffing levels for all staffing outcomes, though average nursing staff levels are lower among for-profitsand government owned NHs when compared to not-for-profits. Results also indicated that for-profit and not-for-profit NHs reacted to increases in Medicaid payment rates similarly (i.e., had higher staffing levels), whereas government NHs responded more strongly to payment increases. By raising Medicaid payment rates, policymakers can address staffing shortages by providing NHs with more financial resources, which in turn allows them to invest in additional nursing staff. Abstract citation ID: igaf122.2691 IS MEDICAID PAYMENT THE KEY TO RAISING STAFFING LEVELS IN NURSING HOMES? INSIGHTS FROM A FACILITY LEVEL ANALYSIS Edward Miller1, John Bowblis2, Elizabeth Simpson1, and Marc Cohen1, 1. University of Massachusetts Boston, Boston, Massachusetts, United States, 2. Miami University, Oxford, Ohio, United States Nursing staff levels are associated with nursing home (NH) quality, but NHs face substantial challenges recruiting and retaining nursing staff. Medicaid, which does not cover the cost of care, is the primary payer for approximately two-thirds of residents, constraining NHs from increasing staff. While past work has studied state-level Medicaid payment rates, there is little work examining the relationship between staffing levels and facility-level payments. This study utilized data from the Payroll-Based Journal data along with Medicaid payment rates collected from states to examine the association between Medicaid rates and staffing levels, and to determine if this association varied by ownership (i.e., for-profit, not-for-profit, government). The study population consisted of 9,513 freestanding NHs in 44 states in 2019. Average staffing levels were calculated for total nursing staff, as well as registered nurses, licensed

FAQs

Why is Medicaid payment relevant to nursing home staffing?

Medicaid is the primary payer for about two-thirds of residents, and it does not cover the full cost of care, limiting facilities’ ability to increase staffing.

What data and time period does the study use?

The study uses Payroll-Based Journal data combined with state Medicaid payment rates, analyzing 9,513 freestanding nursing homes in 44 states in 2019.

How do Medicaid payment rates relate to staffing levels?

Across ownership types, higher Medicaid rates are associated with higher staffing levels for all staffing outcomes, though for-profits and government-owned homes show lower average nursing staff levels than not-for-profits.

Do ownership types respond differently to changes in Medicaid payments?

For-profit and not-for-profit nursing homes react similarly to increases in Medicaid payment rates, while government nursing homes respond more strongly to payment increases.

Sep 29, 2026

Upload by Fahsai