Reg's Blog

Medicaid Case-Mix States: A Reader Question

Recently, a reader asked me a question regarding which states still use RUGs III for their Medicaid case-mix payments. At the time, I honestly didn’t know the answer completely. Based on a little research, I’ve outlined the RUGs status as I currently know it, across the states that utilize Medicaid case-mix. Note: Not all states use a case-mix reimbursement methodology for their Medicaid SNF payments (eighteen don’t). Any readers that know more specifics about any of the states and their status as listed below, are free to comment with additional information.

RUGs IV

1. Washington
2. Minnesota

Transitioning to RUGs IV (either upcoming, very recent or at this point in time)

1. Vermont
2. Wisconsin
3. Illinois
4. Maryland (last cost based state in the country, transition in July of 2014)
5. Indiana (2015)

RUGs III (some may be in the process of developing a transition)

1. Montana
2. Idaho
3. Nevada
4. Utah
5. Colorado
6. North Dakota
7. South Dakota
8. Nebraska
9. Kansas
10. Texas
11. Iowa
12. Louisiana
13. Mississippi
14. Kentucky
15. Ohio
16. Maine
17. New Hampshire
18. New York
19. Pennsylvania
20. West Virginia
21. Virginia
22. North Carolina
23. Georgia

Again, if anyone knows more specifics about any of the above mentioned states, please feel free to comment to this post.

April 7, 2014 - Posted by Reg Hislop III | Skilled Nursing | Case-mix, Medicaid, Nursing Homes, Payment, PPS, RUGs III, RUGs IV, SNF