A recent study estimates Medicaid underfunds long term care by $4.4 billion nationally, a deficit that has risen 45% since 1999.

The current shortfall amounts to an average per patient per day of $13.15 according to the study, conducted for the American Health Care Association, Washington, a group representing nursing homes, assisted living facilities and other care providers.

States with the greatest disparity between the cost of care and Medicaid reimbursement are Illinois, New Jersey, Wisconsin, Minnesota, Vermont, New Hampshire, Missouri, Delaware, Washington and Massachusetts, in order of impact, according to the study

80% of nursing home residents rely on Medicare or Medicaid for their long term care, according to AHCA.