Hospital uncompensated care Archives - Safety-Net Association of Pennsylvania

Supreme Court Lifts Public Charge Rule Ban

The U.S. can now reject visa and green card applicants based on their financial prospects after a new Supreme Court ruling this week.

This ruling has potential long-term implications for health care providers.

Last August a new Department of Homeland Security regulation took effect that authorized the federal government to reject immigrants’ applications for visas and green cards if their financial situation and employment prospects suggested that they might become a “public charge” and dependent on government safety-net programs like Medicaid and food stamps. A number of groups sued to prevent the rule’s implementation and federal courts imposed an injunction against its enforcement but now the Supreme Court has lifted the last of these injunctions.

The Supreme Court’s ruling, however, did not address the merits of the public charge rule. Instead, the court concluded that the lower courts that imposed the injunctions had overstepped their authority. As a result, lower courts will continue to hear individual suits challenging the rule. Meanwhile, the State Department and Department of Homeland Security will enforce it.

In 2019 the State Department rejected 12,000 visa applications. In 2016, it rejected only 1000.

The public charge regulation poses a challenge to health care providers amid anecdotal evidence that some immigrants who already are in the U.S. legally and were enrolled in Medicaid withdrew from the program and others who also are in the U.S. legally and are eligible for Medicaid are choosing not to apply for benefits out of a mistaken fear that they or members of their families could be deported. Over time these practices, if they continue, could leave health care providers with more unpaid bills and a greater uncompensated care burden as they care for individuals who are qualified for Medicaid but decline to enroll in the program and cannot pay their medical bills.

Implementation of the public charge regulation may prove especially challenging for Pennsylvania safety-net hospitals located in areas with large numbers of low-income immigrants. These hospitals could be at risk for rising amounts of uncompensated care.

Learn more about the public charge issue, the Supreme Court’s decision, and what might happen next in the New York Times article “Supreme Court Allows Trump’s Wealth Test for Green Cards.”

PA Safety Net Admin2020-01-29T06:00:41+00:00January 29th, 2020|Federal Medicaid issues, Pennsylvania safety-net hospitals|Comments Off

MACPAC Looks at Medicaid DSH

At a time when cuts in Medicaid disproportionate share hospital payments (Medicaid DSH) are still scheduled for the current fiscal year and some in Congress are calling for a new approach to allotting DSH funds among the states, the Medicaid and CHIP Payment and Access Commission has released its annual analysis of Medicaid DSH allotments to the states.

The report includes:

data about changes in the uninsured rate
demographic information about the uninsured
information about the cost of hospital uncompensated care
perspectives on hospital Medicaid shortfalls
a comparison of hospital uncompensated care costs when calculated using different methodologies
data about hospitals that provide “essential community services”
information about scheduled Medicaid DSH allotment reductions

All Pennsylvania safety-net hospitals receive Medicaid DSH payments and consider the program an essential tool for serving their communities.

MACPAC will issue a more complete report to Congress in March of 2020.

Learn more about how MACPAC views Medicaid DSH at a time when the program is scheduled to change – and when some want even more change – in the new MACPAC document “Required Analyses of Disproportionate Share Hospital (DSH) Allotments.”

PA Safety Net Admin2019-11-08T06:00:38+00:00November 8th, 2019|DSH hospitals, Federal Medicaid issues, Medicaid supplemental payments, Pennsylvania safety-net hospitals|Comments Off

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.”

PA Safety Net Admin2019-08-16T06:00:19+00:00August 16th, 2019|Federal Medicaid issues, Pennsylvania safety-net hospitals|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

U.S. House Committee Looks at 340B

Are hospitals using the savings generated by their participation in the section 340B prescription drug discount program to help their low-income and uninsured patients?
That’s what the U.S. House Energy and Commerce Committee’s Health Subcommittee is asking.
Earlier this year the committee requested such information from the Health Services and Resources Administration, which runs the 340B program, and now it’s asking hospitals as well.
Specifically, the subcommittee sent five-page letters to 19 providers that participate in the 340B program asking them about:

the quantity of 340B-purchased drugs they dispense to Medicare beneficiaries, Medicaid beneficiaries, and those with private insurance
the quantity of 340B-purchased drugs they dispense to uninsured patients
their savings from the 340B program and how they calculate those savings
how much charity care they provide
how they use 340B savings to serve vulnerable populations

The letters address many other 340B-related issues as well.
Most Pennsylvania safety-net hospitals participate in the 340B program and view it as a critical tool in their ability to meet the needs of their many low-income patients.
Learn more about the Health Subcommittee’s letter by reading this news release describing this initiative and go here to view the letters the subcommittee sent to selected 340B providers.

PA Safety Net Admin2017-09-22T06:00:05+00:00September 22nd, 2017|Uncategorized|Comments Off

Hospital Uncompensated Care Down

As was surely expected, reforms introduced through implementation of the Affordable Care Act have driven down uncompensated care costs for many hospitals.
How much?
A new study published by the Commonwealth Fund offers the following findings:

uncompensated care declines in expansion states are substantial relative to profit margins;
for every dollar of uncompensated care costs hospitals in expansion states had in 2013, the Affordable Care Act erased 41 cents by 2015; and
Medicaid expansion reduced uncompensated care burdens for safety-net hospitals that are not made whole by Medicaid disproportionate share payments (Medicaid DSH).

Learn more, including how the decline in uncompensated care costs affected different kinds of hospitals in different kinds of states, in the report “The Impact of the ACA’s Medicaid Expansion on Hospitals’ Uncompensated Care Burden and the Potential Effects of Repeal,” which can be found here, on the Commonwealth Fund’s web site.

PA Safety Net Admin2017-05-16T06:00:57+00:00May 16th, 2017|Affordable Care Act, Pennsylvania safety-net hospitals|Comments Off

Uncompensated Care Down in Medicaid Expansion States

Hospitals in states that chose to take advantage of the Affordable Care Act’s Medicaid expansion option are providing less charity care than hospitals in states that have not expanded their Medicaid programs.
So reports the Colorado Hospital Association after its survey of 465 hospitals in 30 states.
According to the survey, hospitals’ proportion of Medicaid patients increased in states that expanded their Medicaid programs and did not increase in states that did not expand their Medicaid program and uncompensated care fell in states that expanded their Medicaid programs but did not in other states.
Addressing the extent of these changes, the survey found that

The changes seen here are not only distinct, but also substantial. The Medicaid proportion of total charges increased over three percentage points to 18.8 percent in 2014 from 15.3 percent in 2013, representing a 29 percent growth in the volume of Medicaid charges. When compared to the first quarter of 2013, there was a 30 percent drop in average charity care per hospital across expansion states, to $1.9 million from $2.8 million. Similarly, total self-pay charges declined 25 percent in expansion states, bringing its proportion of total charges down to 3.1 percent from 4.7 percent. In contrast, the proportion of Medicare volume shows little variation through first quarter 2014.

Pennsylvania has not yet expanded its Medicaid program but is currently negotiating the terms of doing so with the federal government.
Find the complete Colorado Hospital Association report here.

PA Safety Net Admin2014-06-06T06:00:25+00:00June 6th, 2014|Affordable Care Act, Pennsylvania Medicaid policy|Comments Off

Hospitals Reconsidering Charity Care Policies?

In the wake of Affordable Care Act policies that enhance access to health insurance, hospitals around the country are beginning to take a second look at their charity care policies.
Some are charging co-pays to uninsured patients; others are moving the line at which they provide free or subsidized care.
Such practices are not occurring in great numbers and do not yet constitute a trend, but they do reflect a growing concern among hospitals that some of their uninsured patients have options they are choosing not to exercise.
The New York Times has taken a look at a few hospitals that have reconsidered their long-time charity care policies. Read its report here.

PA Safety Net Admin2014-05-27T10:23:53+00:00May 27th, 2014|Affordable Care Act|Comments Off

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