Medicaid Nursing Home Rates by State

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Missouri

Medicaid nursing facility payment · Cost-based · researched October 2026

Missouri’s Medicaid agency and its state plan are the official source for these rules. This page summarizes them as researched in October 2026; check the state’s own documents, listed under Sources, before relying on them.

At a glance

Rate method

Cost-based

Case-mix level

Facility average

Classification

PDPM

Rate updates

Twice a year

Managed care (LTC)

No

Quality program

NF VBP add-on

Paid outside the rate

Small

Bed hold

Hospital and leave

Published rates

Rates only

Assisted living

Limited

Personal needs allowance

$50 / month

Overview

• Missouri pays each home its own prospective per diem built from its own cost report, capped by statewide ceilings: patient care up to 120% of the median, ancillary up to 120%, administration up to 110%, and capital through a fair rental value (FRV) formula.
• Since 7/1/2022 (13 CSR 70-10.020) only the patient care line is adjusted for acuity, using the home's average Medicaid case-mix index (CMI), updated every January 1 and July 1.
• Small incentives are added on top (4.75% patient care incentive and up to $0.40 multiple-component incentive), along with value-based purchasing (VBP) quality add-ons, a $5 mental illness add-on, the $12.93 provider-tax (NFRA) pass-through and a $10 SFY2024 add-on.
• Rates were rebased to 2019 costs for 7/1/2022 and to 2022 costs for 7/1/2024.
• No home's rate can fall below its 6/30/2022 rate.
• The Jan 1, 2026 rate list has 477 active homes: median $246.83/day, middle 80% $196.40-$305.67, full range $160.51-$483.34 (the top is the one HIV facility).
• The median was $186.77 on 7/1/2022.

What matters in Missouri

• No home's rate can fall below its 6/30/2022 rate, a standing hold-harmless floor.
• Rebasing happens only when the legislature funds it; the 2001 cost base stayed frozen until 2022.
• Public homes (27 nursing home districts, 4 county, 1 municipal) get an annual UPL lump sum toward unreimbursed Medicaid cost; private homes do not (13 CSR 70-10.160).
• Case mix is per home since 7/1/2022, using the Medicaid average PDPM nursing index each January and July.
• $3.42/day per quality measure met, up to $23.94/day, scaled by the home's total quality score tier.
• Hospital bed hold pays the full per diem only if Medicaid beds were 97% full the prior quarter.
• From 1/1/2027, state MDS reviews can only lower rates, with recoupment back to the original effective date.

Frequently asked

Does Missouri allow a home's Medicaid rate to fall below its mid-2022 rate?

No. No home's rate can fall below its 6/30/2022 rate, a standing hold-harmless floor.

How does Missouri score its nursing home quality add-on?

The add-on pays $3.42 per day for each long-stay measure met, up to $23.94 per day, scaled from 0% to 100% by the home's total quality score tier.

When does Missouri Medicaid pay the full per diem to hold a bed?

For hospital holds, only when Medicaid beds were 97% full in the prior quarter. Up to 24 therapeutic leave days a year are paid.

How much is paid outside the posted rate in Missouri?

Small, probably under 5% of base: an annual payment-limit lump sum to 32 public homes, size not found.

What does Missouri Medicaid pay on Medicare coinsurance days?

Medicaid pays its rate minus Medicare's payment, capped at the coinsurance, so homes usually receive $0.

Does Missouri require a minimum share of spending on care?

No; only a small $0.10-$0.20 incentive rewards homes whose care share is at least 70%.

How is the Missouri nursing home provider tax charged?

$12.93 per occupied day on all payers, returned as a flat $12.93 in every Medicaid per diem.

How the rate is set

How the method got here

Verified October 11, 2026

Cost basis

Uses cost reports

Yes

Cost report

State-specific 'Financial and Statistical Report for Nursing Facilities' (Title XIX cost report MSIR-1 (3-95)), filed annually on the home's federal tax fiscal year, due the first day of the 6th month after year end; desk/field audited by MHD or its contractor (Level I-III audits).

Base year and rebasing

No fixed rebasing cycle; rebasing happens when the legislature funds it. 1992 base (rates 1995-2004); 2001 base from 7/1/2004 (annual rebasing was adopted in 2004 but dropped from 7/1/2005, so the 2001 base stayed frozen until 2022); 2019 base from 7/1/2022; 2022 base from 7/1/2024 ('SFY 2025 rebase', +$116.0M/yr). At each rebase, 2% is added to aide, dietary, laundry, housekeeping and beauty/barber salaries (for minimum wage). Costs are trended to June 30 of the rate year, and patient care costs are case-mix neutralized to the statewide average total CMI. Homes on interim rates are excluded from the data bank (from the SFY2025 rebase), and so are cost reports of 3 months or less. Hospital-based and HIV homes have separate data banks. New homes get a prospective rate from their 2nd full-year cost report.

Components

Component	Method	Notes
patient care	Lower of the home's allowable cost per day (after the 2% salary adjustment and trend, case-mix neutralized: cost x statewide average total CMI / home's cost-report total CMI) or a ceiling of 120% of the neutralized median. The result is then multiplied by the home's Medicaid CMI / statewide average CMI, recalculated every Jan 1 and Jul 1.	Projected SFY2023 ceiling $127.12 (MHD summary). Covers nursing, aides, dietary and related lines 46-70 of the cost report. Worked example in the rule: base $105.79 x 0.8206/0.8744 = $99.28.
ancillary	Lower of the home's allowable cost per day (trended, with 2% salary adjustment) or 120% of the median. Not case-mix adjusted.	Projected SFY2023 ceiling $21.48. Covers laundry, housekeeping, plant operation, therapy-type and other ancillary lines (71-101).
administration	Lower of the home's allowable cost per day or 110% of the median. Cost is divided by the greater of actual days or 80% occupancy days (85% before 7/1/2022).	Projected SFY2023 ceiling $35.83. Central office/management fees capped at 7% of gross revenue less contractual allowances.
capital (FRV)	Fair rental value. Asset value per bed (RS Means median NF construction cost per bed x Missouri city index; $64,701 for 2019) x total facility size (licensed beds plus bed equivalents for capital spending), less 1% per year of weighted average age (max 40%), x a rental rate of 6.375% (2.5% depreciation + 30-yr Treasury 1.875% as of 1/1/2022 + 2%). Divided by the greater of actual or 80% occupancy days. Property insurance, real estate and personal property taxes are a trended pass-through on the same 80% floor.	Rental value is recalculated every July 1 (facility size, age and asset value from the 3rd-prior-year cost report). From the SFY2025 rebase, homes that cut licensed beds to run single-occupancy rooms can have size and occupancy measured on April 1 licensed beds. Capital increases from a change of ownership are not recognized.
NFRA pass-through	The current Nursing Facility Reimbursement Allowance (provider tax) per day, $12.93, is added to every home's rate after the hold-harmless comparison.	See provider_tax_detail.

Inflation

CMS Nursing Home without Capital Market Basket, 'Total - %MOVAVG' (IHS Markit/S&P Global Healthcare Cost Review Table 6.7). Used only at rebasing, to trend base-year costs from the cost report midpoint to the rate year (2022:2 index for the 2019 base; 2024:2 index for the 2022 base). There is no automatic annual inflation update between rebasings; increases between rebasings come as legislated flat 'global per diem adjustments'.

Verified October 11, 2026

Case mix

System

PDPM

Applied at

Facility average

How it works

Each home gets one rate for all its Medicaid residents. Its patient care line is scaled by its average Medicaid CMI (PDPM nursing-component weights) from the two prior quarterly snapshots, reset every Jan 1 and Jul 1 (13 CSR 70-10.020(11)(A)2 and (11)(H)1).

Classification

PDPM nursing component only (the 25 nursing case-mix groups and FY2024 SNF PPS CMIs effective 10/1/2023), assigned hierarchically, from 7/1/2024. Before that, RUG-IV 48-group (index maximizing), 7/1/2022-6/30/2024. No case mix at all before 7/1/2022.

Applies to

Patient care component only (about 60% of the cost-component per diem). Ancillary, administration, capital, incentives, VBP, MI add-on and NFRA are not acuity-adjusted.

Acuity measured from

Quarterly point-in-time snapshots on Jan 1, Apr 1, Jul 1 and Oct 1, using the midnight census. Each resident's most recent MDS (OBRA or PPS) with an ARD within the 180-day look-back is used, and the facility value is a simple average. The Medicaid CMI includes Medicaid-pending, Medicaid hospice and Medicaid managed care residents; the total CMI covers all residents. Jan 1 rates use the Jul 1 + Oct 1 snapshots; Jul 1 rates use Jan 1 + Apr 1. Facilities review draft resident listings; payer-source fixes go to MHD and MDS fixes through iQIES. Statewide average used when no data. Jan 2026 Medicaid CMI on the rate list: median 1.2711, range 0.7393-2.1085.

Updated

semi-annual (Jan 1 and Jul 1)

Move to PDPM

Switched from RUG-IV 48 to the PDPM nursing component effective 7/1/2024 (SPA 24-0019, the same amendment as the 2022-cost rebase), after CMS ended RUG support on 10/1/2023. RUG-based rates ran through 6/30/2024 using MDS data through 9/30/2023. Patient care costs were re-neutralized in the 2022 rebase; from 7/1/2025 the cost-report total CMI is a resident-weighted (not simple) average of the four quarters (SPA 25-0012).

Verified October 11, 2026

Low-acuity residents

None. Missouri has no reduced or flat rate for low-acuity residents. Low acuity lowers a home's average Medicaid CMI and so its patient care line; it is never a separate per-resident rate. The rule has no 'default' or lowest class rate for missing assessments: residents with no MDS in the 180-day look-back are left out of the average, and the statewide average CMI is used when a home has no data. Gatekeeping is through level of care instead: a person must score at least 18 points on the DHSS Nursing Facility Level of Care Assessment (19 CSR 30-81.030) for Medicaid to pay at all. Checked: 13 CSR 70-10.020 (4/30/26), MHD Nursing Home Manual (5/11/2026), MHD NF FAQ (rev. 5/3/2023).

Verified October 11, 2026

Capital

Fair rental value (13 CSR 70-10.020(11)(D)). Asset value per bed (RS Means median NF construction cost per bed, adjusted by the Missouri city index; $64,701 for 2019, updated annually) x total facility size (licensed beds plus bed equivalents: capital spending / asset value per bed for that year, rounded down). The age reduction is 1%/year of weighted average age, max 40%; capital spending lowers the effective age. Rental rate 6.375% (2.5% depreciation on a 40-year life + 3.875% return = 30-yr Treasury 1.875% on 1/1/2022 + 2%). Rental value per day = rental value / (facility size x 365 x greater of 80% or actual occupancy). Property insurance, real estate tax and personal property tax are a trended pass-through on the same 80% floor. Rental value is updated every July 1 for bed changes, capital spending (3rd-prior-year cost report), age and asset value. No capital increase is recognized for a change of ownership.

Verified October 11, 2026

Budget adjustment factor

None in the current method. (1) Hold harmless/floor: a home's rate can never fall below its 6/30/2022 prospective rate (13 CSR 70-10.020(11)(H)5), and the base rate is the greater of the newly computed per diem or the 6/30/2022 rate excluding NFRA. (2) Every global adjustment is 'contingent upon appropriation' and CMS approval. Historically: an FY2018 cut of $5.37/day (8/1/2017), reduced to $4.83 from 7/1/2018; a FY2019 add-on of $1.29 trimmed to $0.54; an FY2020 add-on of $1.61 trimmed to $1.49; and a one-year COVID add-on of $10.18 in FY2022, removed 7/1/2022 (13 CSR 70-10.016).

Verified October 11, 2026

Add-ons and money outside the rate

Paid outside the posted rate

Level

small

Estimate

Probably under 5% of base, but not measured. The only off-rate program is the annual public NF UPL payment to 32 government-owned homes (about 7% of homes), based on their unreimbursed Medicaid cost; its size was not found. VBP, MI, ventilator and global add-ons are all inside the posted per diem, and there are no MCO directed payments.

Components

Public Nursing Facility UPL payment (13 CSR 70-10.160): annual, size unknown. Nurse aide training reimbursement (13 CSR 70-10.120): minor. Extraordinary-circumstance one-time payments: rare.

Source

https://www.sos.mo.gov/cmsimages/adrules/csr/current/13csr/13…

Verified October 11, 2026

Payments by owner type

Applies

yes

Detail

Only public NFs ('owned or operated by a public entity') that sign an agreement with DSS get the annual UPL supplemental payment for unreimbursed Medicaid cost. 32 active homes on the Jan 2026 list: 27 nursing home districts (GD), 4 county (GC), 1 municipal (GM). Their median 1/1/2026 posted rate is $230.67 vs $248.29 for other homes, so the UPL lump sum partly fills that gap. The dollar gap and the number actually paid were not found. Nursing home district/county tax levies are also not offset against their cost (13 CSR 70-10.020(9)).

Funding

Not stated in the rule; the state share is presumably IGT or certified public expenditure from the public owner. No lease or management arrangement for private operators described.

Source

https://www.sos.mo.gov/cmsimages/adrules/csr/current/13csr/13…

Verified October 11, 2026

Quality program

Program

Value Based Purchasing (VBP) Incentive per diem add-on (13 CSR 70-10.020(11)(F)3), since 7/1/2022

Funding

State general revenue plus federal match through the per diem (appropriated). Not a carve-out from base rates, and not paid through MCOs. The SFY2026 increase was budgeted at $3.11M ($1.08M state + $2.03M federal).

Size

Not published as a pool. Up to 7 x $3.42 = $23.94/day before the tier percentage (SFY2026 on). Derived estimate: the +$0.38/measure increase cost $3.11M/yr, which implies roughly $28M/yr total VBP spending at $3.42 ($3.11M x 3.42/0.38). This is an estimate, not a state figure.

Paid as

Per diem add-on built into each home's Medicaid rate, re-scored every Jan 1 and Jul 1.

Measures

Measure	Source	Weight	How points are earned
Decline in late-loss ADLs (long-stay)	MDS QM (CMS)	$3.42/day	<= 10.0%
Decline in mobility on unit (long-stay)	MDS QM (CMS)	$3.42/day	<= 8.0%
High-risk long-stay residents with pressure ulcers	MDS QM (CMS)	$3.42/day	<= 2.7%
Long-stay antipsychotic medication use	MDS QM (CMS)	$3.42/day	<= 6.8%
Long-stay falls with major injury	MDS QM (CMS)	$3.42/day	<= 1.3%
Long-stay indwelling catheter	MDS QM (CMS)	$3.42/day	<= 1.1%
Long-stay urinary tract infection	MDS QM (CMS)	$3.42/day	<= 1.9%
Total QM score (8 long-stay QMs: the 7 above + physical restraints)	MDS QM points from CMS Five-Star Technical Users' Guide Table A3 (January 2017)	multiplier on the earned add-on	Tier 1 >= 600 points = 100%; Tier 2 >= 520 = 75%; Tier 3 >= 440 = 50%; Tier 4 >= 360 = 25%; below 360 = 0%

Scoring period

Each home's most recent 12-month rolling average QM values: data as of May 15 for the Jul 1 rate, as of Nov 15 for the Jan 1 rate (initially values as of 1/21/2022 for 7/1/2022). Prior-period data carries forward when no update exists. Lag is about 6-9 months from the measured quarters to payment.

Payment formula

Add-on = (number of the 7 QM thresholds met x per-measure amount) x VBP percentage from the total QM score tier. Per-measure amounts: $1.00 (SFY2023), $1.87 (SFY2024), $3.04 (SFY2025), $3.42 (from 7/1/2025). Example in the rule: 2 measures x $1.00 x 75% = $1.50/day.

Eligibility

Any home with a prospective rate on or after 7/1/2022 that meets the thresholds. No survey or SFF disqualifier in the rule. Homes lose any add-on they no longer qualify for at the next semi-annual review.

Cadence

Scored semi-annually; paid on every Medicaid day through the per diem.

Scores published

No separate VBP scorecard found. The rate list shows only the total rate and Medicaid CMI, not the VBP line.

Notes

Thresholds and the point table are frozen to CMS's January 2017 Five-Star Table A3, so they do not move with CMS's later cut-point updates. Two of the eight measures (mobility decline and physical restraints) have since been dropped from CMS's Five-Star QM rating, so Missouri scores some measures CMS no longer rates.

Verified October 11, 2026

Provider tax

Charged

per occupied day (all payers, including Medicare and private), from the DHSS Certificate of Need quarterly survey

Standard amount

$12.93 per patient occupancy day, effective 7/1/2018 (13 CSR 70-10.110(2)(Q); unchanged in the rule as amended effective 3/30/2026). The rule caps it at the federal 6% of net patient revenue limit (42 CFR 433.68).

Tiers

Who	Test	Amount
Nursing facilities operated by the Department of Mental Health	public	exempt
New CON facilities in their first period	other	assessed on 50% of licensed bed days, prorated
Homes that permanently cut licensed beds by >= 15% so their assessed days exceed new capacity	size	reassessed on new licensed beds x 365, prospectively
Homes with SNF and ICF beds and none Medicaid-certified	other	only SNF-licensed beds taxed

Lower for high-Medicaid homes

no

Returned in the rate

The NFRA is an allowable cost and the 'rebased rate' = base rate + the NFRA in effect ($12.93/day), so every home's Medicaid per diem carries a flat $12.93. Homes recover it on Medicaid days only; tax paid on Medicare and private days is not returned by Medicaid.

Source

https://www.sos.mo.gov/cmsimages/adrules/csr/current/13csr/13…

Verified October 11, 2026

Provider tax notes

Nursing Facility Reimbursement Allowance (NFRA), sections 198.401-198.439 RSMo and 13 CSR 70-10.110: $12.93 per patient occupancy day (all payers) since 7/1/2018 (peak $13.40 in 2015-2018). The annual amount = rate x (previous December quarterly survey occupied days x 4), collected monthly, usually by offset against Medicaid payments. The NFRA is an allowable cost and is added to every Medicaid rate as a $12.93 per diem.

Verified October 11, 2026

Supplemental payments

(1) Public Nursing Facility UPL payments (13 CSR 70-10.160, since 7/1/2013): an annual lump sum after each state fiscal year to public NFs (owned or operated by a public entity) that sign an agreement with DSS. It is based on each home's unreimbursed Medicaid cost from the second-prior-year cost report, capped in aggregate at the Medicare UPL (42 CFR 447.272). 32 active public homes on the Jan 2026 rate list (27 nursing home districts, 4 county, 1 municipal). Annual size not found. (2) No MCO directed payments (NF is fee-for-service). (3) Historical: 2nd-tier high volume adjustment (2002-2004, funded by certified public funds) and Enhancement Pools (13 CSR 70-10.150, rescinded 2018).

Verified October 11, 2026

Other add-ons

(1) SFY2024 global per diem adjustment: +$10.00/day from 7/1/2023, re-added after every semi-annual recalculation (13 CSR 70-10.020(12)(A)1). (2) Patient care incentive: 4.75% of the home's patient care per diem, with patient care + incentive capped at 130% of the median (10% before 7/1/2022). (3) Multiple component incentive: $0.10-$0.20 if patient care + ancillary is >= 70% of the total per diem, plus $0.10-$0.20 more if Medicaid utilization is >= 85% (max $0.40/day; recalculated semi-annually from 7/1/2025). (4) VBP add-on, up to $23.94/day x tier % (see quality_incentive). (5) Mental illness diagnosis add-on: $5.00/day if at least 40% of the home's Medicaid residents have schizophrenia or bipolar disorder, re-checked each Jan 1/Jul 1 from the October/April final resident listings. (6) Invasive ventilator add-on: $150/day per qualifying resident (13 CSR 70-10.017). (7) Extraordinary-circumstance adjustments (uninsured disasters, vandalism): a one-time lump sum or a per diem within the ceilings. (8) Nurse aide training: reimbursed outside the rate, up to $1,500 per aide prorated by Medicaid share (13 CSR 70-10.120).

Verified October 11, 2026

Units paid separately

(1) Invasive Ventilator Program (13 CSR 70-10.017, since 1/1/2013): +$150/day for adults fully ventilator-dependent, with MHD pre-certification (every 90 days if weaning), enrolled homes, contiguous rooms and a DME contract; the ventilator itself is billed by the DME provider. (2) HIV nursing facility: separate data bank and rate (one home, Hope Care Center, $483.34 on 1/1/2026). (3) Hospital-based NFs (4 on the list): with < 1,000 Medicaid days, no cost report needed and paid the sum of the patient care, ancillary and administration ceilings + median capital + 4.75% of the patient care median. With >= 1,000 days, the same unless the home asks for a cost-based rate. (4) New homes: interim rate = 100% of the patient care ceiling + 90% of the ancillary and administration ceilings + 95% of median capital, until a prospective rate is set from the 2nd full-year cost report (retroactive). (5) Out-of-state placements: lower of the Missouri weighted average rate or the home state's rate. (6) State-operated ICF/IID and DMH facilities are under separate rules (13 CSR 70-10.030/.060). (7) Hospice residents: MHD pays the hospice, which pays the NF room and board based on the NF per diem, less the resident's surplus income.

Verified October 11, 2026

Payment rules

Managed care for long-term care

Status

no

Detail

MO HealthNet Managed Care (Healthy Blue, Home State Health, UnitedHealthcare; Show-Me Healthy Kids specialty plan) covers families, children, pregnant women and expansion adults. Aged/disabled (ME codes 01, 04, 11, 13, 14, 16), blind and all Medicare-eligible people are excluded and paid fee-for-service. The NF rate rule counts 'Medicaid managed care residents' in the facility's Medicaid CMI, so a few MCO enrollees do live in homes, but no MCO long-stay NF benefit or MCO NF rate was found.

Verified October 11, 2026

Who pays

fee_for_service. Aged, permanently and totally disabled, blind, and Medicare dual-eligible people are excluded from MO HealthNet Managed Care and served fee-for-service (managed care contract RFPS30034902200777 sec. 1.7.4). Nursing facility care is not in the MCO comprehensive benefit package; MO HealthNet pays homes directly from the posted rate list.

Verified October 11, 2026

Managed care rate floor

Not applicable: nursing facility care is paid fee-for-service at the posted MO HealthNet per diem. No MCO NF rate floor or directed payment found.

Verified October 11, 2026

Included in the daily rate

Included (13 CSR 70-10.020(5) and Appendix A; NH Manual 5/11/2026): semi-private room and board (private if medically needed), nursing, personal hygiene, all laundry, all dietary including tube-feeding supplements, consultative services and 'all therapy services required by federal or state law or regulations', routine supplies and equipment (wheelchairs, beds, mattresses, lifts, respiratory equipment such as nebulizers and suction), oxygen and delivery systems/concentrators, IV supplies, ostomy/catheter/wound supplies, non-legend antacids, laxatives, stool softeners and vitamins, and therapeutic home and qualifying hospital leave days. Paid separately: prescription drugs (pharmacy program; non-allowable on the cost report), physician and other professional services, invasive ventilators through DME, nurse aide training (13 CSR 70-10.120). Medicare Part B revenue is offset against cost. Lab/x-ray treatment not stated.

Verified October 11, 2026

Bed hold

Hospital stays

Paid at the home's full per diem only if all of the following hold: the home had >= 97.00% occupancy of its Medicaid-certified beds in the prior calendar quarter (DHSS CON quarterly survey); the hospital stay is 3 days or less for a condition that can't be treated as an outpatient; the hospital discharge plan returns the resident to the home; and the resident has enough leave days left. Each hospital leave day uses up 2 therapeutic leave days (13 CSR 70-10.070).

Leave days

Paid at the full per diem, up to 12 days in the first 6 calendar months and 12 days in the second 6 months (24/yr), if in the plan of care and ordered by a physician; includes visits to friends and family.

Occupancy rule

97% occupancy of Medicaid-certified beds in the prior quarter for hospital leave; none for therapeutic leave.

Notes

Beyond these limits, bed holds are non-covered; residents may pay privately to hold a bed but cannot be required to. Leave days count as patient days in cost reports.

Source

https://www.sos.mo.gov/cmsimages/adrules/csr/current/13csr/13…

Verified October 11, 2026

Personal needs allowance

Per month

50

Effective

In force; reached the $50 cap in RSMo 208.016 (manual section cites IMs from 2004 to 2020)

Notes

MO HealthNet for the Aged, Blind, and Disabled Manual 0815.030.10.05: 'Allow a $50 personal needs allowance standard for vendor participants' (nursing-home residents); $50 also for participants with the $90 reduced VA pension; raised further for court-ordered child support. RSMo 208.016 raised it yearly by a COLA formula (max $5/yr) until it reached $50; no further increases unless appropriated.

Confidence

confirmed

Source

https://dssmanuals.mo.gov/mo-healthnet-for-the-aged-blind-and…

Verified October 11, 2026

Medicare coinsurance days

Method

lesser_of

Rule

Medicare Part A SNF coinsurance days (days 21-100): MO HealthNet pays the lower of (a) the home's Medicaid per diem x approved coinsurance days minus what Medicare paid for those days, or (b) the coinsurance amount. Nothing is paid unless the Medicaid rate x days exceeds the Medicare payment. Medicare Advantage/Part C: the same lesser-of rule, only for QMB-Only and QMB-Plus enrollees, billed as a UB-04 Part C crossover claim on the MHD portal; coinsurance days are as set by each MA plan. A home may not also bill a Medicaid NF claim for the same days (13 CSR 70-10.020(3)(S), in place since 4/1/2010).

Effect

Because Medicare's PDPM payment almost always exceeds the Missouri per diem (median about $247), the home usually gets $0 of the day-21+ coinsurance from Medicaid.

Source

https://www.sos.mo.gov/cmsimages/adrules/csr/current/13csr/13…

Verified October 11, 2026

Required care spending

Applies

no

Rule

No current requirement to spend a share of Medicaid revenue on care. Historical only: the 7/1/2000 Quality Assurance Incentive ($3.20/day) had to be spent on direct patient care (13 CSR 70-10.015(13)(B)9.B). That amount is now folded into rates held at or above the 6/30/2022 level and is no longer tracked separately. The rate design itself rewards a high direct-care share through the multiple-component incentive ($0.10-$0.20 if patient care + ancillary >= 70% of the per diem), with no penalty.

Source

https://www.sos.mo.gov/cmsimages/adrules/csr/current/13csr/13…

Verified October 11, 2026

Occupancy rules

Applies

yes

Rule

(1) Administration cost and the capital (FRV rental value and pass-through) components are divided by the greater of actual days or 80% of licensed (or certified) bed days; this was 85% before 7/1/2022. The administration median is computed on the same basis. (2) Hospital bed-hold days are paid only if the home was >= 97% occupied in the prior quarter. (3) Homes that cut licensed beds to single-occupancy rooms can have FRV size and occupancy measured on April 1 licensed beds (from SFY2025). (4) NFRA tax is based on occupied days; new homes are taxed on 50% of bed days.

Source

https://www.sos.mo.gov/cmsimages/adrules/csr/current/13csr/13…

Verified October 11, 2026

MDS accuracy penalties

MDS reviews since 7/1/2024 (13 CSR 70-10.020(4)(KK)4 and (12)(D)5; contractor Myers and Stauffer). RN reviewers check selected assessments from the latest final resident listing; unsupported assessments are reclassified, the Medicaid CMI is recalculated, and the per diem is revised back to its original effective date. Phase-in: reviews completed 7/1/2024-12/31/2025 could only raise rates (training period); reviews completed in calendar 2026 adjust both ways (pay-backs or recoupments); reviews completed from 1/1/2027 only lower rates (recoupment). Homes with a high share of unsupported assessments may need a Validation Improvement Plan, and suspected record alteration is referred to the Medicaid Fraud Control Unit. No fixed error-rate threshold or penalty percentage beyond the CMI recalculation.

Verified October 11, 2026

Published rates and changes

How often rates change

A home's rate changes

semiannual

When

Jan 1 and Jul 1: Medicaid CMI (patient care line), VBP add-on, mental illness add-on and multiple-component incentive are recalculated. Jul 1 also brings the annual FRV capital update and any legislated global adjustment or rebase. Rates cannot fall below the 6/30/2022 rate. Retroactive revisions follow MDS reviews or audits.

Verified October 11, 2026

When rates change

July 1 state fiscal year plus a January 1 semi-annual update. A new home's first prospective rate is retroactive to the start of its second full fiscal year. MDS-review revisions are retroactive to the revised rate's start date. Rates are decided by MHD letter, appealable to the Administrative Hearing Commission.

Verified October 11, 2026

Posted rates

Home-level rates published

Yes

Where

https://dss.mo.gov/mhd/fee-schedules-rate-lists ('Nursing Facility Rate List')

Format

xlsx

Cadence

Re-posted after each semi-annual rate update. The current file is the 1/1/2026 rates (report date 3/23/2026); no 7/1/2026 list was posted as of Oct 2026.

History

One file carries every rate since the 7/1/2022 rebase (7/1/2022, 1/1/2023, 7/1/2023, 1/1/2024, 7/1/2024, 1/1/2025, 7/1/2025, 1/1/2026) with the Medicaid CMI for each period from 7/1/2024. Earlier rate lists were not found on the site.

Home identifier

MO HealthNet 'Pseudo Number' (e.g. IR10547) plus provider name, city, county, urban/rural, FYE, entity type (LLC/PC/NO/NCR/NCO/PPT; GD/GC/GM = district/county/municipal government), licensed and Medicaid beds, and rate type (prospective, interim, hospital-based, HIV, terminated). No CCN or NPI.

Verified October 11, 2026

Rate build-ups

Published

No

Where

Not posted. Each home gets an MHD rate decision letter (appealable to the AHC). Worked component examples are in 13 CSR 70-10.020(11). The posted list shows only the total rate and Medicaid CMI.

What they show

n/a. The rate list gives total per diems by period and the Medicaid CMI, not the component build-up (patient care, ancillary, administration, FRV, incentives, VBP, MI, NFRA).

Format

xlsx (rate list only)

Example file

https://dss.mo.gov/sites/mydss/files/media/file/2026/03/Nursi…

Verified October 11, 2026

Recent changes

Verified October 11, 2026

Assisted living

Medicaid assisted living

Covered

limited

Program

State plan personal care and advanced personal care (13 CSR 70-91.010), authorized by DHSS. They can be delivered to residents of licensed Residential Care Facilities I/II and Assisted Living Facilities, as well as in private homes. No ALF-specific 1915(c) waiver bundle found.

What is paid

Services only, by the unit (agency-billed personal care tasks; in group settings, aide time is divided among residents and documented by shift). Room and board is paid by the resident. Total monthly basic personal care for a person cannot exceed 60% of the average statewide monthly NF cost. MHD sets separate unit rates for private homes and for RCFs/ALFs.

Limits

Must be Medicaid-eligible and assessed by DHSS as needing care as an alternative to NF placement; capped at 60% of average NF cost (basic personal care). No waitlist found.

Source

https://www.sos.mo.gov/cmsimages/adrules/csr/current/13csr/13…

Verified October 11, 2026

Sources

1. 13 CSR 70-10 (Code of State Regulations, MO HealthNet NF reimbursement chapter; current through 4/30/26): 70-10.015, .016, .017, .020, .070, .110, .120, .160 · regulation
2. MO HealthNet Nursing Facility Rate List (1/1/2026 rates, report date 3/23/2026) · rate file
3. MHD Fee Schedules & Rate Lists page · agency page
4. MHD Nursing Home Reimbursement page · agency page
5. Missouri Medicaid NF Reimbursement Methodology Summary for FY2023 · agency page
6. NF Reimbursement FAQs, SFY2023 methodology (rev. 2, 5/3/2023) · agency page
7. Public Notice: NF reimbursement methodology, SPA 24-0019 (6/28/2024) · agency page
8. Public Notice: NF reimbursement methodology, SPA 25-0012 (6/30/2025) · agency page
9. MO HealthNet Nursing Home Provider Manual (published 5/11/2026) · agency page
10. MO HealthNet Managed Care Program RFP/contract RFPS30034902200777 (eligibility groups sec. 1.7) · agency page
11. Benefit Table: Nursing Facilities (12/2025) · agency page
12. 13 CSR 70-91 Personal Care Program · regulation
13. Benefit Table: Personal Care (12/2025) · agency page
14. MHD Proposed Rules / Public Notices page (checked for FY2027 NF notices) · agency page
15. Personal needs allowance · secondary

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