Payment Policy Reform

Our Position

State contracting standards and reimbursement methods are needed that reward providers for superior performance with regard to improving job quality. Making workforce an explicit part of the CMS review processes would be an important first step.

The federal government needs to exercise greater oversight of and provide more specific guidance to states regarding the adequacy and quality of their direct-care workforces.

What We're Doing

  • Monitoring developments in state payment and procurement practices and policies.
  • Analyzing and presenting options for state payment and procurement policies that encourage provider investment in quality direct-care jobs.
  • Advocating for greater CMS guidance and oversight of state payment policies that impact workforce adequacy and stability


Our country’s reimbursement rates for nursing facility and home- and community-based services are not structured to support adequate, stable staffing. Indeed, of the $59 billion of Medicaid payments for institutional services, and an additional $42 billion for Medicaid home- and community-based services, only a small fraction is leveraged to encourage providers to adopt human resource practices consistent with high-quality service delivery.

Reimbursement rates can be used to generate competitive pressures that push quality up and costs down by providing financial rewards or incentives for high productivity or superior performance with respect to staffing adequacy and stability.

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