PDPM Medicaid Is Here. Are You Ready?
PDPM Medicaid is already reshaping how skilled nursing facilities get paid—and most providers aren’t ready. This isn’t just a rate change. It’s a full overhaul of how care is coded, reimbursed, and documented for long-term care residents in many states.
PDPM Medicaid Experts. Proven Results.
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What PDPM Medicaid Really Means for Skilled Nursing
PDPM Medicaid isn’t just a new acronym in your reimbursement mix — it’s a signal that the foundation of long-term care funding is shifting. While it borrows from the Medicare model, the Medicaid implementation affects a very different population, under very different constraints. And most operators are finding that what worked before simply won’t work now.
But here’s the challenge:
Every state is implementing it differently.
Some are adopting only the nursing component. Others are incorporating NTA, Speech Therapy, or even all five components. Some states have finalized their rates, while others are still releasing last-minute changes—leaving providers scrambling to adjust even as implementation is active or imminent.
This isn’t a theoretical change. It directly affects:
How much you get paid per patient per day
What documentation is required to support payment
How you train and deploy your clinical team
Whether your current billing and coding processes are still viable
If your team is still operating under a RUGs mindset—or worse, relying on therapy-driven reimbursement strategies—you may already be losing money without realizing it.
Not sure where your state stands?
Check the latest updates in our State-by-State Transition Guide or schedule a strategy call to assess your readiness.
The Risks of Being Unprepared
Even experienced providers are finding that what worked under RUGs doesn’t translate under PDPM Medicaid. Too often, the assumption is that “we already transitioned to PDPM for Medicare—so we’re covered.”
That assumption is costing some facilities thousands in missed reimbursement.
Here’s where we see the biggest breakdowns:
Therapy still driving strategy: Many providers are still relying on therapy utilization to sustain their CMI, not realizing it no longer drives reimbursement in most states under this transition.
Section GG documentation gaps: Without consistent and accurate Section GG input from nurse aides, LPNs, or interdisciplinary staff, providers are underreporting functional needs—and getting paid less as a result.
Inadequate coding alignment: ICD-10 coding and diagnosis selection must now not only directly reflect acuity and resource utilization, but repeat documentation is required at each quarterly or annual MDS to ensure accuracy of reimbursement. Misalignment between documentation and code selection is leading to lost nursing, NTA and Speech Therapy reimbursement.
Missed ARD strategy windows: Without a clear process for capturing time-sensitive clinical changes (like IV use, wound progression, or new diagnoses), facilities are missing opportunities to maximize the accuracy of reimbursement.
Lack of interdisciplinary coordination: Rehab, nursing, MDS, and billing teams often aren’t aligned on what matters under your state’s reimbursement model—leading to inconsistent documentation and misfired assessments.
Overconfidence from Medicare PDPM success: Just because you performed well under Medicare PDPM doesn’t mean your team is ready for how Medicaid states are interpreting and implementing it.
These aren’t theoretical risks. We’ve already worked with providers who lost $5–$15 per patient per day simply because no one updated their internal processes.
Not sure where your exposure is? Schedule a free strategy call and we’ll help you identify the gaps.
State-by-State PDPM Medicaid Transition Guide
PDPM Medicaid is not a uniform federal rollout—it’s being implemented state by state, and there are multiple options for it is being applied.
Some are only adopting the nursing component. Others are incorporating NTA, Speech Therapy, or even all five components of PDPM. A few have published clear rate structures. Many have not. And changes are still coming—sometimes with just weeks of notice before they go into effect.
That’s why we built the PDPM Medicaid State-by-State Transition Guide—a centralized resource to help you keep up with what your state is doing, and what’s coming next.
Inside the guide you’ll find:
Which components of PDPM each state is implementing
Whether rates have been finalized
Where to find your state’s official Medicaid guidance
Notes on evolving regulations, deadlines, and billing strategy implications
Struggling with PDPM Medicaid? Let’s Fix That.
Schedule a conversation to understand how the shift in Medicaid payment is impacting your facility and discover the strategies that can protect your margins.
Expert Guidance and Resources on PDPM Medicaid Implementation
We’ve been guiding providers through PDPM since its Medicare debut in 2019. Now that Medicaid is rolling out its own version—state by state, rule by rule—the confusion is mounting, and the stakes are higher than ever.
To help you stay ahead, we’ve pulled together key resources that reveal where providers are falling behind, how to spot risk in your own operations, and what to do before your margins take the hit.
Will PDPM Medicaid Sink Your Facility?
Gravity Healthcare Hacks – Episode 58
In this episode, Melissa Brown sits down with MDS expert Melissa Keiter to break down where most facilities are getting it wrong—from outdated therapy strategies to documentation blind spots—and what you can do to stop margin erosion before it starts.
The Real Risks of PDPM Medicaid (And How to Stay Ahead)
Missed Section GG documentation. Misaligned ICD-10 codes. ARD timing mistakes. This article breaks down the most common traps providers are falling into under PDPM Medicaid—and the high-dollar impact they’re already seeing.
What’s Next?
We’re actively expanding our content library—including state-specific breakdowns, coding strategy tips, and documentation playbooks.
Stay tuned—and subscribe for updates to get new resources as they go live.
Where Gravity Fits into Your PDPM Strategy
PDPM Medicaid isn’t just a policy change—it’s a complete shift in how your facility earns reimbursement. And it’s happening whether your team is ready or not.
At Gravity Consulting, we work with providers across the country to operationalize this Medicaid change—from clinical workflows to documentation alignment and coding accuracy.
We don’t offer theory. We step in, assess the gaps, and help you fix them—fast.
Together, we’ll tackle challenges like:
Identify reimbursement leaks tied to poor Section GG or ARD execution
Train CNAs, LPNs, and interdisciplinary teams on documentation
Align your coding practices to capture the full picture of resident acuity
Develop new workflows for MDS, billing, and therapy teams under PDPM
Navigate your state’s evolving Medicaid policies with clarity and confidence
Whether you’re just starting to feel the impact—or already seeing cuts to your CMI—we can help you get ahead of it.
Let’s talk through your challenges and create a plan that actually works.
Frequently Asked Questions About PDPM Medicaid
Is PDPM Medicaid the same as Medicare PDPM?
No. While the PDPM structure was originally developed for Medicare, many states are now adapting it for Medicaid long-term care reimbursement. But each state’s version is different—some use only portions of PDPM, others add their own case-mix weights or assessment rules.
How do I know if my state is using PDPM for Medicaid?
We’ve built a state-by-state guide that shows which states have transitioned (or are in the process of transitioning) to PDPM Medicaid. Bookmark it—it’s updated regularly.
What are the biggest mistakes facilities are making?
Most facilities underestimate how different the Medicaid versions are from Medicare PDPM. Top issues include misaligned ARD timing, weak Section GG scoring, and underreporting clinical complexity—which all lead to missed reimbursement.
Can PDPM Medicaid lower my facility’s case-mix index?
Yes, and for many providers, it already has. PDPM Medicaid ties reimbursement more directly to documented acuity. If your documentation or assessment processes aren’t capturing complexity, your CMI will drop—even if resident needs haven’t changed.
What if I don’t have the bandwidth to retrain my team?
That’s where Gravity comes in. We offer hands-on support—from MDS coaching to therapy alignment—so you’re not stuck trying to fix this on your own.
Get The Help You Need
Whether you’re already seeing the financial impact—or just starting to feel the pressure—this transition isn’t going away.
And you don’t have to figure it out alone.
Gravity has helped providers across the country prepare for and navigate the shift to PDPM Medicaid. From documentation audits to staff training to MDS realignment, we’ve been in the trenches, solving the exact problems you’re facing.
Let’s have a real conversation about what’s happening in your building. We’ll walk through where you stand and what’s needed to strengthen your margins.