Each state designs and implements its medical eligibility criteria and processes for nursing facility services based on the state’s interpretation of federal law and regulation. This report examines Maryland’s system for Medicaid-reimbursed nursing facility services and community-based alternatives and provides recommendations for improvement.
This article, published in the Journal of Ambulatory Care Management, describes the risk-adjusted payment methodology employed by the Maryland Medicaid program to pay managed care organizations. It also presents an empirical simulation analysis using claims data from 230,000 Maryland Medicaid recipients.