Federal Medicaid issues Archives - Page 8 of 11 - Safety-Net Association of Pennsylvania

Administration Ramps Up Scrutiny of Immigrants’ Use of Public Benefits

Immigrants’ sponsors could be more likely to be held financially responsible for the cost of public benefits those immigrants receive under a new memorandum issued by the White House.

The requirement itself is not new; the purpose of the memorandum is to encourage federal agencies to enforce existing laws that state that, according to the memorandum,

…when an alien applies for certain means-tested public benefits, the financial resources of the alien’s sponsor must be counted as part of the alien’s financial resources in determining both eligibility for the benefits and the amount of benefits that may be awarded. Financial sponsors who pledge to financially support the sponsored alien in the event the alien applies for or receives public benefits will be expected to fulfill their commitment under law.

Among the means-tested public benefits programs at which this new directive is aimed are Medicaid, the Supplemental Nutrition Assistance Program (SNAP, formerly food stamps), and Temporary Assistance for Needy Families (TANF).

While the law already requires agencies to enforce immigrants sponsors’ legal financial responsibilities, the White House memorandum notes that it is not being enforced and directs the federal agencies involved to review and update their enforcement procedures.

Enforcement of this directive could result in fewer people applying for and being found eligible to receive Medicaid. If this occurs, it could be especially harmful to Pennsylvania safety-net hospitals that serve large immigrant communities, potentially leaving them unpaid for care they provide to such patients.

Learn more from the administration’s “Memorandum on Enforcing the Legal Responsibilities of Sponsors of Aliens.”

PA Safety Net Admin2019-06-06T06:00:12+00:00June 6th, 2019|Federal Medicaid issues, Pennsylvania safety-net hospitals|Comments Off

Medicaid DSH Delay Wins Bipartisan Support

More than 300 members of the U.S. House have joined a letter to House leadership urging a delay in Affordable Care Act-mandated cuts in Medicaid disproportionate share payments (Medicaid DSH).

The bipartisan letter notes that hospitals that receive Medicaid DSH funds cannot absorb the loss of revenue such a cut would bring. That cut, scheduled to begin in FY 2020, would amount to a $4 billion reduction in nation-wide Medicaid DSH spending in FY 2020 and an $8 billion reduction in each of FY 2021, FY 2022, FY 2023, FY 2024, and FY 2025.

SNAP was actively involved in urging Pennsylvania House members to join the letter. If implemented, the Medicaid DSH cuts would be especially harmful to SNAP members and all Pennsylvania safety-net hospitals – and to the low-income residents of the communities they serve.

See the bipartisan letter seeking a delay of Medicaid DSH cuts here.

PA Safety Net Admin2019-05-24T06:00:46+00:00May 24th, 2019|Affordable Care Act, DSH hospitals, Federal Medicaid issues, Medicaid supplemental payments|Comments Off

Tackling Social Determinants of Health

Two states are working to address social determinants of health through their Medicaid programs.

In California and Oregon, the state Medicaid programs are using care coordination and funding from multiple sources, including traditional Medicaid funding, alternative payment approaches, and savings from care coordination to provide services such as housing, food, and legal assistance while also building the capacity of health care and community groups to support such efforts. Both states obtained federal Medicaid waivers to enable them to expend Medicaid resources on non-Medicaid-covered services.

Learn more about how California and Oregon are using their Medicaid programs to address social determinants of health in the Health Affairs report “Medicaid Investments To Address Social Needs In Oregon And California.”

PA Safety Net Admin2019-05-15T06:00:53+00:00May 15th, 2019|Federal Medicaid issues, social determinants of health|Comments Off

CMS Speeds Up Medicaid Review Process

The federal government has greatly increased the speed with which it is reviewing and approving state applications to modify their Medicaid programs.

Most often, such applications involve Medicaid state plan amendments and section 1915 waiver requests.

According to a recent post on the CMS blog (in CMS’s own words),

Between calendar years 2016 and 2018, there was a 16 percent decrease in the median approval time for Medicaid SPAs [note: state plan amendments].
Seventy-eight percent of SPAs were approved within the first 90 day review period during calendar year 2018, a 14 percent increase over 2016.
Between calendar year 2016 and 2018, median approval times for 1915(b) waivers decreased by 11 percent, 1915(c) renewal approval times decreased by 38 percent, and 1915(c) amendment approval times decreased by 28 percent.
The backlog of pending SPA and 1915 waiver actions pending additional information from the states was reduced 80 percent from previous years.

Learn more in the CMS blog entry “CMS Streamlines Medicaid Review Process and Reduces Approval Times so States Can More Effectively Manage Their Programs.”

PA Safety Net Admin2019-05-13T06:00:33+00:00May 13th, 2019|Federal Medicaid issues|Comments Off

New Poverty Level Standards to Jeopardize Medicaid Eligibility?

The Trump administration is considering changing how the federal government measures inflation for the purpose of calculating the federal poverty level.

Such a change, if implemented, could potentially reduce inflation-related increases in the federal poverty level, which in turn could limit the ability of some individuals and families to qualify, or continue to qualify, for a variety of public safety-net services – including, potentially, Medicaid.

Among the possible alternatives to the current methodology for calculating inflation is the Chained Consumer Price Index for All Urban Consumers. The Obama administration also explored substituting this index for the current inflation factor.

Any change that makes it more difficult for people to qualify for Medicaid could be particularly damaging to Pennsylvania safety-net hospitals, which are generally located in communities with especially large numbers of low-income residents. If patients lose their Medicaid eligibility because the criteria for participating in the program change, that could leave such hospitals serving even more uninsured patients and providing even more uncompensated care than they already do.

The federal Office of Management and Budget has issued a request for comment about various inflation factor calculation alternatives. Go here to see OMB notice Request for Comment on the Consumer Inflation Measures Produced by Federal Statistical Agencies. Comments are due in late June. Learn more from the New York Times article “Trump Administration Seeks to Redefine Formula for Calculating Poverty.”

PA Safety Net Admin2019-05-10T06:00:54+00:00May 10th, 2019|Federal Medicaid issues, Pennsylvania safety-net hospitals|Comments Off

SNAP Asks Congress for Help on Medicaid DSH

Prevent Medicaid DSH cuts: that is the message the Safety-Net Association of Pennsylvania conveyed to Pennsylvania’s congressional delegation this week.

In a message sent to every member of the U.S. House of Representatives from Pennsylvania, SNAP asked members to sign onto a letter to House Speaker Nancy Pelosi asking her to delay Affordable Care Act-mandated cuts in Medicaid disproportionate share payments (Medicaid DSH) that are scheduled to take effect in October of this year.

If implemented, the cut would hurt 179 of Pennsylvania’s 213 hospitals, including all safety-net hospitals, and cost the state approximately $240 million in Medicaid DSH revenue in FY 2020 and $480 million a year in FYs 2021 through 2025.

See the letter requesting action on Medicaid DSH cuts here and SNAP’s message to Pennsylvania’s congressional delegation here.

PA Safety Net Admin2019-04-24T14:49:48+00:00April 24th, 2019|Affordable Care Act, DSH hospitals, Federal Medicaid issues, Medicaid supplemental payments, Pennsylvania safety-net hospitals, Safety-Net Association of Pennsylvania|Comments Off

MACPAC Recommends Changes in Medicaid Shortfall Definition

Hospitals’ calculation of their Medicaid shortfall would change under a recommendation that MACPAC voted to make to Congress. That change, in turn, could affect hospitals’ future Medicaid disproportionate share payments.

Last week the Medicaid and CHIP Payment and Access Commission voted overwhelmingly to change how hospitals calculate their Medicaid shortfall: the difference between what they spend caring for their Medicaid patients and what Medicaid pays them for that care. Under MACPAC’s proposal, hospitals would need to deduct from their shortfall total all third-party payments they receive for the care they provide to their Medicaid patients.

If this proposal were to be adopted, it has the potential of changing Medicaid DSH allocations among the states and change the distribution of Medicaid DSH funds within individual states, although the Congressional Budget Office estimates that it would have little impact on either measure.

Complicating the MACPAC recommendation is last year’s federal court ruling that third-party payments could not be deducted from hospitals’ Medicaid shortfall totals because the Centers for Medicare & Medicaid Services lacks the authority to implement such a policy. Making such a change therefore would require action by Congress.

Learn more about the MACPAC recommendation and its potential implications for hospitals and their Medicaid DSH payments in the Fierce Healthcare article “’Medicaid shortfall’ definition should change when tallying DSH payments, MACPAC says.”

PA Safety Net Admin2019-04-19T06:00:38+00:00April 19th, 2019|DSH hospitals, Federal Medicaid issues, Medicaid supplemental payments|Comments Off

Delay Medicaid DSH Cut, Pelosi Says

Medicaid DSH cuts should be delayed, House Speaker Nancy Pelosi (D-CA) told a gathering of hospital officials.

According to Speaker Pelosi,

DSH cuts threaten to erode the health of community hospitals, safety-net hospitals and rural hospitals, [affecting] the health of not only the families that rely on Medicaid, but any person who relies on these hospitals for care.

SNAP members all receive Medicaid DSH payments and would be harmed if the scheduled cut takes effect on October 1.

Learn more about Speaker Pelosi’s remarks in the Becker’s Hospital Review article “House speaker urges Congress to ease Medicaid payment cuts to hospitals serving low-income patients.”

PA Safety Net Admin2019-04-15T06:00:36+00:00April 15th, 2019|DSH hospitals, Federal Medicaid issues, Medicaid supplemental payments, Pennsylvania safety-net hospitals|Comments Off

ACA Repeal Would Drive Up Uninsured, Uncompensated Care

At the same time that the Trump administration announced that it has asked a federal court to repeal the entire Affordable Care Act, the Urban Institute has published a report detailing the potential impact of the health care reform law’s repeal.

According to the Urban Institute report, repealing the entire Affordable Care Act would add almost 20 million Americans to the ranks of the uninsured. Medicaid and CHIP enrollment would fall by 15.4 million people and millions of others would lose the tax credits they used to purchase insurance. Some would purchase insurance with limited benefits and individual plan premiums would rise while others would go uninsured.

In addition, repeal of the Affordable Care Act would lead to an 82 percent increase in hospital uncompensated care, to more than $50 billion. About half of the states would see the amount of uncompensated care provided by their hospitals double, the Urban Institute estimates.

Repeal of the Affordable Care Act would pose an especially great financial challenge for Pennsylvania safety-net hospitals because they care for so many Medicaid- and CHIP-covered and low-income patients who might lose their coverage if the reform law is repealed. About 700,000 new people have enrolled in the state’s Medicaid program since the state implemented the Affordable Care Act’s optional Medicaid expansion.

Learn more from the Healthcare Dive article “Killing ACA would lead to huge spikes in uncompensated care” and from the Urban Institute report State-by-State Estimates of the Coverage and Funding Consequences of Full Repeal of the ACA.

PA Safety Net Admin2019-03-28T06:00:09+00:00March 28th, 2019|Affordable Care Act, Federal Medicaid issues, Pennsylvania safety-net hospitals|Comments Off

Medicaid Transportation Services in Jeopardy?

The White House has proposed removing non-emergency transportation from the list of mandatory Medicaid benefits.

The proposed FY 2020 budget released last week explained that

Statute allows, but does not require, States to provide non-emergency medical transportation (NEMT). Instead, these services were made mandatory Medicaid benefits by regulation. Further, a Government Accountability Office study found Medicaid NEMT spending totaled $1.5 billion in 2013, and NEMT programs face multiple challenges, including difficulties in obtaining costs and maintaining program integrity. To address these issues, this proposal would update regulations to clarify the NEMT benefit is strictly optional.

Medical transportation has long been viewed as vital means for helping Medicaid patients keep doctors’ appointments and recover from their illnesses and injuries and for overcoming some social determinants of health. Loss of this tool would be harmful for Pennsylvania safety-net hospitals and the patients and communities they serve.

PA Safety Net Admin2019-03-25T06:00:07+00:00March 25th, 2019|Federal Medicaid issues|Comments Off

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