That's true, but one of the outrageous things is that here in TN, the state charges nursing homes over $2600/month bed tax. There is no way it costs the state $2600/month per bed to inspect nursing homes. So why is the bed tax so high? Because in most cases, the FEDs were paying for it. They created a massive incentive for States to institute high taxes and run up the cost of Medicare to the end users.
2006 TN bed tax
Medicaid bed taxes and institutional bias