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State Policy Levers to Address Nursing Facility Staffing Issues

Published: March, 2022

Related MEDPAC Publications

Many nursing facilities have fewer direct care staff than needed to meet the care needs of their residents, a problem more common in nursing facilities that serve a high share of Medicaid-covered residents. Because such facilities also have a higher share of Black and Hispanic residents, the low staffing rates in these facilities contribute to health disparities. The COVID-19 pandemic exacerbated these disparities further. (Weech-Maldonado 2021).

Although the federal government plays an important role in monitoring compliance with its staffing standards, states can also help address staffing challenges in several ways, including:

  • increasing Medicaid payment rates to help facilities hire more direct care staff and pay them higher wages;
  • changing Medicaid payment methods to incentivize facilities to spend more of their revenue on staff (e.g., wage pass-through payment policies that require facilities to spend a specified portion of the Medicaid rate on staff wages); and,
  • requiring that facilities meet minimum staffing standards that exceed federal requirements.

MACPAC has documented state policies related to nursing facility staffing in State Policies Related to Nursing Facility Staffing (MACPAC 2022). This brief provides background information about staffing challenges before the COVID-19 pandemic, summarizes current state policies related to staffing, and discusses prior research about the effectiveness of these policies.

Medicaid and CHIP Payment and Access Commission. “State Policy Levers to Address Nursing Facility Staffing Issues”. https://www.macpac.gov/wp-content/uploads/2022/03/State-Policy-Levers-to-Address-Nursing-Facility-Staffing-Issues.pdf.  Accessed December 2022.