State Medicaid programs underfunded nursing homes by $5.6 billion last year. They paid an average of $7.17 per hour, per patient, which is less than the minimum wage of $7.25 per hour, according to a new study.

Such a shortfall is not acceptable, especially as the system prepares for an influx of baby boomers, according to Mark Parkinson, president and CEO of the American Health Care Association, which released the study. The report, compiled by the research firm Eljay, found that states with the largest Medicaid per patient day underfunding were New York, Illinois, Massachusetts, Minnesota, New Jersey and Washington.

Nursing homes in some states fill the gap with payments from Medicare, but Parkinson warns that Medicare is already too pinched and that it’s dangerous for states to rely on it.

In related developments, despite financial and budget woes, states met targeted expansions and improvements to state Medicaid and children’s health insurance programs. They were even able to provide coverage to millions of low-income Americans, according to a survey released by the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured.