Will PDPM Medicaid Sink Your Facility? What You Need to Know Before You Fall Behind the Curve

The clock is ticking. With the mandatory transition to PDPM Medicaid coming October 1st, many providers are still unprepared—and it’s already impacting their margins.

In this episode, Melissa Brown is joined by Melissa Keiter, MDS expert and Lead Consultant for Nursing Services at Gravity Consulting, to break down the real-world implications of this sweeping policy shift. From reimbursement cuts to team readiness, they explore why relying on therapy-driven documentation is no longer enough—and what nursing homes must do to avoid sinking under PDPM Medicaid.

You’ll learn:

• Why some facilities are already losing $5–$15 per patient per day
• How Section GG impacts your bottom line—and why nurse aides hold the key
• What to do if your state is including therapy in the Medicaid rate
• Tactical strategies for nursing-only states
• How to prepare your entire care team—from dietitians to social workers

This is part one of a two-part series. Don’t miss this critical conversation designed to help you protect your CMI and stay financially afloat during the transition.

Transcript

Melissa Brown:
Welcome back to Gravity Healthcare Hacks. I’m Melissa Brown, Chief Operating Officer at Gravity Consulting—and your self-professed healthcare nerd. Today we’re tackling one of the most urgent issues facing long-term care: Will PDPM Medicaid sink your facility?

Some providers will thrive under PDPM Medicaid. But many are facing serious cuts to reimbursement, and most don’t even realize it yet.

Joining me today is Melissa Keiter, our MDS expert and Lead Consultant for Nursing Services at Gravity. Melissa, thanks for being here.

Melissa Keiter:
Thanks, Melissa. I’m excited to talk about this—it’s definitely a hot topic. We’ve talked to so many clients and colleagues who are wondering: Are we ready for this shift? Do our teams even understand what’s changing?

Melissa Brown:
Exactly. We’re seeing a lot of communities that think they’ve transitioned to PDPM Medicaid, but they haven’t made any meaningful changes. And when they don’t adjust, they’re falling behind—often by $5, $10, or even $15 per patient per day. That’s a huge hit to reimbursement.

Melissa Keiter:
It really starts with team readiness. Your frontline staff—nurse aides, LPNs, social workers, dietitians—they all need to understand how their documentation impacts CMI and reimbursement under PDPM.

Melissa Brown:
Right. And we’ve created a free State-by-State PDPM Medicaid Guide that breaks down what each state is doing. Some are implementing all five components of PDPM, while others are only doing nursing or nursing + NTA. It’s all over the place.

Melissa Keiter:
If your state is including PT, OT, and Speech in Medicaid payments, you need strong GG documentation. Therapists must communicate any functional declines, changes in diet or swallowing, and accurate ICD-10 coding. And they must coordinate with the MDS team.

Melissa Brown:
Absolutely. Under RUGs, therapy could carry your CMI score. Not anymore. Now, it’s about capturing functional status and clinical characteristics accurately—and that often falls to your nursing team, not therapy.

Melissa Keiter:
That’s why training nurse aides to document Section GG daily is critical. They’re the eyes and ears of the facility. And once it becomes routine, it’s not a burden—it’s just part of good care.

Melissa Brown:
If you take one thing away from this episode: You can’t rely on therapy anymore. If your nurse aides aren’t documenting Section GG, you're missing out on appropriate reimbursement. It’s that simple.

Melissa Keiter:
Exactly. And for nursing-only states, it’s all about capturing clinical indicators—IVs, wound care, shortness of breath, malnutrition—during that seven-day lookback window. Pull your 24-hour report, schedule UDAs, and train your nurses on what to watch for.

Melissa Brown:
This conversation was so packed with strategy that we’re splitting it into two episodes. Be sure to catch Part 2, where we dive even deeper into how facilities can adapt and protect their CMI under PDPM Medicaid.

Thanks for listening—and remember: It’s not just what you know, it’s how you apply it that makes all the difference.