New Public Charge Rule Could Affect Immigrants, Providers
Legal immigrants may become reluctant to seek government-sponsored health care and providers may find themselves delivering more uncompensated care in the wake of the adoption of a new federal “public charge” regulation that seeks to define more narrowly the kinds of individuals who should be granted entry to the U.S. in the future.
The new Department of Homeland Security regulation, while focused on applicants for entry into the U.S., could have the unintended effect of discouraging legal immigrants from enrolling in Medicaid, CHIP, and other government programs and even lead them to disenroll from such programs out of a mistaken concern that participating in such programs could jeopardize their status as legal immigrants. The Kaiser Family Foundation, in fact, estimates that two to three million people will leave Medicaid and CHIP because of the new regulation.
More than a quarter of a million interested parties responded to the proposed regulation, which was published last October, and since its release last week a wide variety of groups, ranging from the American Hospital Association and America’s Essential Hospitals to the American Council of Pediatrics, have noted the new regulation’s potential impact with alarm. Hospitals, in particular, are concerned that if people disenroll from Medicaid and CHIP, they will end up providing more uncompensated care to patients who previously had health insurance through those two public programs.
This could be especially challenging for Pennsylvania safety-net hospitals that are located in communities with large numbers of low-income legal immigrants.
Learn more about the new public charge regulation and health care providers’ reaction to it in the Fierce Healthcare article “Healthcare industry groups warn final ‘public charge’ rule could impact immigrant health, drive up costs.”
The decline results, according to the news release, from a combination of prevention, rescue, and treatment. These and efforts, including the distribution of free naloxone, a drug that helps rescue those who have overdosed on some drugs, have been funded in part by a grant from the U.S. Substance Abuse and Mental Health Services Administration and Pennsylvania’s own Substance Use Disorder Loan Repayment Program, which assists health care professionals who work in the behavioral health field with the cost of their education.
The report details individual hospital performance on these procedures, including in-hospital mortality, complications, and extended post-operative length of stay. In addition, it breaks down hospital performance for all of these measures and all of these procedures based on patient age, income, gender, geographic location, and race and ethnicity.
The new requirements apply both to Medicaid fee for service and managed care programs and all of these steps must be completed by the end of calendar year 2019.
As envisioned by the state, the current program, in which individual counties contract independently with transportation providers to serve their residents on Medicaid, was to be replaced by a regional approach in which the state contracts with three vendors to serve all of Pennsylvania. Objections by members of the state legislature and county officials, however, led to legislation that requires the Department of Human Services, Department of Transportation, and Department of Aging to study the implications of such a change for patients and taxpayers and to report their preliminary findings to the legislature in September.
According to a legislative summary prepared by one of the bipartisan bill’s sponsors,
Or so reports a new study from the National Bureau of Economic Research.
In 2015, CMS required states to track their Medicaid fee-for-service payments and submit them to the federal government as part of a process to ensure that Medicaid payments were sufficient to ensure access to care for eligible individuals. Now, CMS proposes rescinding this requirement, writing in a news release that
The Medicaid DSH cuts, mandated by the Affordable Care Act, have already been delayed three times by Congress and could be on their way to a fourth delay if the proposal advanced by the Health Subcommittee is endorsed by the Energy and Commerce Committee and works its way to the full House of Representatives, where such a proposal is thought to enjoy wide support.
According to the post, social determinants of health – income, education, decent housing, access to food, and more – significantly influence the health and well-being of individuals – including low-income individuals who have adequate access to quality health care. Medicaid, the post maintains, can play a major role in addressing social determinants of health.