States ranked by the ratio of their average base Medicaid payment to their average cost of care for Medicaid-covered residents of nursing facilities. A ratio of less than one means costs are higher than payments.
| State | Avg. base payment | Avg. cost of care | Ratio | % below 1 | % 1 or more |
|---|---|---|---|---|---|
| Delaware | $375.82 | $290.39 | 1.29 | 42.4% | 57.6% |
| Hawaii | $357.14 | $309.72 | 1.15 | 33.4% | 66.7% |
| Oregon | $354.36 | $318.75 | 1.11 | 19.4% | 80.6% |
| Alabama | $204.60 | $205.36 | 1.00 | 39.7% | 60.3% |
| West Virginia | $305.83 | $305.85 | 1.00 | 45.4% | 54.6% |
| District of Columbia | $299.07 | $305.04 | 0.98 | 55.6% | 44.4% |
| Minnesota | $275.77 | $288.62 | 0.96 | 67.2% | 32.8% |
| Virginia *|** | $196.19 | $204.16 | 0.96 | 60.7% | 39.2% |
| Arkansas | $186.85 | $198.41 | 0.94 | 59.0% | 41.0% |
| Georgia ** | $187.66 | $199.86 | 0.94 | 54.6% | 45.3% |
| Mississippi | $202.65 | $215.42 | 0.94 | 51.3% | 48.8% |
| North Dakota | $282.42 | $301.20 | 0.94 | 78.6% | 21.4% |
| Maryland | $263.69 | $284.95 | 0.93 | 75.1% | 24.8% |
| Tennessee | $203.33 | $219.71 | 0.93 | 71.1% | 28.8% |
| Maine | $247.74 | $271.30 | 0.91 | 78.3% | 21.8% |
| Illinois | $192.87 | $213.70 | 0.90 | 77.1% | 22.9% |
| Iowa | $185.06 | $206.15 | 0.90 | 81.7% | 18.3% |
| Kansas | $188.46 | $209.02 | 0.90 | 70.2% | 29.8% |
| Louisiana | $162.56 | $180.55 | 0.90 | 73.1% | 26.9% |
| Missouri | $161.24 | $178.49 | 0.90 | 71.1% | 28.8% |
| North Carolina | $186.25 | $208.07 | 0.90 | 72.3% | 27.8% |
| Oklahoma | $153.03 | $169.65 | 0.90 | 72.2% | 27.9% |
| Rhode Island * | $226.79 | $252.59 | 0.90 | 88.0% | 12.0% |
| Indiana ** | $210.75 | $238.78 | 0.88 | 77.6% | 22.4% |
| Kentucky | $195.17 | $221.37 | 0.88 | 79.5% | 20.5% |
| Vermont | $244.82 | $281.58 | 0.87 | 87.6% | 12.5% |
| Colorado | $227.42 | $265.56 | 0.86 | 86.2% | 13.8% |
| Ohio | $196.72 | $230.11 | 0.86 | 86.4% | 13.6% |
| National average | $200.39 | $238.94 | 0.84 | 81.6% | 18.4% |
| California * | $225.53 | $269.25 | 0.84 | 91.8% | 8.3% |
| Montana | $204.52 | $244.31 | 0.84 | 87.6% | 12.5% |
| New Mexico | $198.46 | $240.49 | 0.83 | 96.3% | 3.6% |
| Connecticut | $226.83 | $278.34 | 0.82 | 93.3% | 6.8% |
| Massachusetts * | $209.87 | $256.59 | 0.82 | 93.1% | 6.8% |
| Arizona | $209.32 | $257.50 | 0.81 | 91.9% | 8.1% |
| Michigan ** | $208.49 | $258.01 | 0.81 | 95.3% | 4.6% |
| Texas | $157.76 | $195.28 | 0.81 | 88.2% | 11.9% |
| Washington | $229.57 | $285.65 | 0.80 | 91.7% | 8.3% |
| South Carolina | $158.50 | $205.07 | 0.77 | 99.4% | 0.7% |
| Utah | $201.73 | $263.03 | 0.77 | 89.8% | 10.3% |
| New York | $228.81 | $302.07 | 0.76 | 92.8% | 7.2% |
| Wisconsin | $185.85 | $249.14 | 0.75 | 87.4% | 12.6% |
| Florida | $184.31 | $250.37 | 0.74 | 96.2% | 3.9% |
| Pennsylvania ** | $186.77 | $254.67 | 0.73 | 96.5% | 3.5% |
| New Jersey * | $193.66 | $268.08 | 0.72 | 93.5% | 6.5% |
| Wyoming ** | $175.93 | $254.82 | 0.69 | 100.0% | 0.0% |
| South Dakota | $125.51 | $209.02 | 0.60 | 100.0% | 0.0% |
| Nebraska | $129.53 | $223.91 | 0.58 | 100.0% | 0.0% |
| Nevada ** | $151.89 | $263.36 | 0.58 | 100.0% | 0.0% |
Percentages may not equal 100% due to rounding
* Managed care allowed amounts not available; base payment amounts only reflect fee-for-service spending.
** Estimates of Medicaid base payments relative to costs are likely much lower than total Medicaid payments relative to costs for some facilities in these states due to the percentage of supplemental payments.