Emanuel Medical Center in rural Georgia loses more than $350,000 each month by providing care to low-income, uninsured patients. But state Medicaid officials say the new state funding proposal could significantly reduce the deficit of most rural hospitals in Georgia, not just the 66-bed Swainsboro facility.
This story was also published in Kaiser Health News
This is not the Medicaid expansion that Republican leaders in Georgia have rejected. Instead, state community health departments are taking advantage of the low-profile Medicaid funding opportunities that are being rapidly adopted by more than 35 states, including most states that have expanded government insurance programs.
Additional federal funds will bedirect payment” — Available only in states that employ health insurance companies to provide Medicaid services.
In 2020, these special flows of funds approved by federal health officials transferred more than $25 billion to states, according to the Medicaid and CHIP Payments and Access Commission (MACPAC), which advises Congress.
Centers for Medicare & Medicaid Services contacted KHN for individual state expenditures when asked for the latest totals. “CMS does not publish total expenditures related to state-mandated payments,” said agency spokesperson Bruce Alexander.
But the Government Accountability Office, congressional oversight agencies, and MACPAC said federal health officials are doing more to monitor specified payments and assess whether states are meeting program goals. stated that it is necessary to This includes improving access and quality of care. These agencies say more transparency is needed.
a Last year’s MACPAC report found that less than 25% of designated payment plans that have been running for at least one year have reviewable ratings.
Debra Lipson, a senior fellow at Mathematica, a consulting firm that studies the issue, said federal health officials “have been getting a lot of questions” about direct payments from GAO and MACPAC. “That’s a lot of money.”
CMS has yet to release a report on the program’s quality metrics, Lipson added.
CMS spokesperson Alexander said the agency “takes our role in oversight and transparency seriously and is working with our federal and state partners to improve oversight and transparency of designated payments.” I will.”
Medicaid is a government health insurance program for low-income and disabled patients. It is jointly funded by state and federal governments.
CMS launched the Preferred Payments Program in 2016. Georgia officials estimate the state will provide her $1 billion in federal funding to hospitals and other health care providers this year through a designated payments program.
California estimates it brought more than $6 billion to new federal funds through directed payments last year alone. Arizona received $4.3 billion between She’s 2018 and He’s 2022. florida net Over $1 billion in the 12 months ending September.
This special Medicaid funding may indirectly help patients by providing the potential for capital improvements through additional cash injections, as well as enhancing the financial stability of hospitals.
But patient advocates and Democratic lawmakers in Georgia said it was more urgent to provide coverage for the medical needs of the uninsured by adopting Medicaid expansion. Like Emanuel Medical Center Hospitals will benefit from Medicaid reimbursements for high-backed patients.
The uninsured “does not get preventive care, which drives up health care costs,” said Atlanta-area Democrat state senator Elena Parent. “States should have expanded Medicaid,” she said.
That expansion won’t happen in Georgia in the near term, as Republican Governor Brian Kemp plans to begin new restrictions on Medicaid enrollment for low-income adults. job requirements attached.
Under directed payments, additional funding for hospitals and other Medicaid health care providers is available through a variety of avenues, including minimum fees for services, increased general reimbursement, and salary increases based on quality of care. flows.
Payment is based on the amount of services provided. If one hospital serves more Medicaid patients than another hospital, its reimbursement will be higher, Lipson said.
“CMS was initially surprised by the number of state directed payment offers,” says Lipson. In some states she has more than 25, she added. Must be updated annually. In many cases, the state funds its portion through hospital valuations or funds transferred from public funds such as hospital authorities, county governments, and state agencies.
There are five such designated payment plans in Georgia. Kayleigh Nogle, commissioner of the state and community health department that runs Medicaid in Georgia, said their goals include increasing Medicaid payments to hospitals and doctors, strengthening the health workforce, and improving health and equity. said to include improving sexuality.
Atlanta’s Grady Memorial Hospital, a large safety net provider, said it expects to make $139 million in profits from its four programs in Georgia.
Ryan Loke, Grady’s Chief Health Policy Officer, said: “Without this money, Grady would be in a worse position.”
Grady sees more Medicaid and uninsured patients who previously used the nearby Atlanta Medical Center. closed last year.
State Senator Ben Watson, a physician and Savannah Area Republican, said safety-net hospitals like this one, which serve the majority of people without health insurance, would receive higher compensation through Medicaid-directed payments. As a result, it helped cover some of the losses. .
Georgia plans to use these funding streams as a platform to extend additional support to local hospitals.
The additional payments will bring Grady and other hospitals closer to or reach the usual funding limits for hospitals that serve a “disproportionate proportion” of impoverished patients. The state will send approximately $100 million of this surplus to local hospitals.
The Georgia Hospital Association said the specified payments are helpful but do not cover the cost of charity care for the uninsured.
“They didn’t see [hospitals’] Group executive Anna Adams said: “Patients who have insurance are healthier patients. We want as many people as possible to be covered.”
Meanwhile, officials at regional hospitals in Georgia are excited about the prospect of increased Medicaid funding.
Jimmy Lewis, CEO of HomeTown Health, the state’s association of local hospitals, said:
Emmanuel Medical Center CEO Damian Scott said he was “cautiously optimistic” about future allocations. On his wish list is attracting a pediatrician to his county (currently none) and having space to move the hospital’s only MRI machine from the truck to the hospital building. .
As things stand, “we struggle month after month to survive,” he said.
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