State Medicaid reimbursement for ICF-MR facilities in the 1978-1986 period.

Medicaid policies for Intermediate Care Facilities for the Mentally Retarded (ICF-MR) are important because of rapid expenditure growth. Our study of 1978-1986 state Medicaid ICF-MR reimbursement policies showed massive shifts from traditional retrospective reimbursement methods, paralleling changes in reimbursing skilled nursing facility and ICF care. Meanwhile, Medicaid per diem ICF-MR reimbursement rates increased about 67%. Regression analysis showed that personal income, population percentage in poverty, unionization, and percentage of ICF-MR beds in government facilities influenced rates positively, whereas prospective class and combination reimbursement methods negatively affected rates. Thus, within the context of economic factors, government involvement in care and the reimbursement methodology are policies found to affect rates.