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View Diary: Morning Feature: Chuck Grassley, "Medicaid Fraud" and the IRS (305 comments)

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  •  Nice job, TFLS. You and I could get into a long (21+ / 0-)

    geeky discussion TFLS. I'm always struck about how different stares handled the uninsured. You write:

    Lacking insured clientele, health care providers in low-income communities use Medicaid to subsidize astronomical rates of unreimbursed care and to stay afloat. In other words, Medicaid payments are used to cover the costs of undocumented workers, low-income adults between the ages of 19 and 54 (who qualify for neither Medicaid, which covers children, nor Medicare, which covers the elderly), and individuals such as those with mental illness who find it difficult to apply for help.

    In NYS, undocumented workers can get their health care charges reimbursed through Medicaid for emergency care only. So, for example, an undocumented worker is admitted through the ER and requires follow up care in the diabetic clinic. OK. They can apply for Medicaid and if he/she is otherwise eligible (income and residency status, eg) Medicaid will pay for the inpatient charges. However, the Medicaid is only good for the inpatient admission, not the follow up visit to the Diabetes clinic, or for any other outpatient visit.

    The safety net hospital where I worked incurred millions in uncompensated care and don't I wish we could have received enough through Medicaid to recognize our uncompensated care. Rather, we had to turn to the NYS bad debt and charity care pools. We received $40,000,000 from these pools. We were only permitted to receive these monies if we could prove that we actually billed and dunned non-paying patients. In other words, a billing system just like every other business. We even sent non-payers to a collection agency. And, again, we were a safety net hospital. (We fee-scaled patients to manageable amounts, however.)

    The pools in NYS are classic Marxism: from each according to his ability to each according to his need. In other words, every hosp in NYS pays into this pool and through a formula the money is reallocated to the hospitals with big uncompensatd care needs.

    As you point out, there are various tweaks to the Medicaid/Medicare programs to drive more money to safety net and other hospitals: The disproportionate share add-on, direct and indirect medical ed add-ons, and higher reimbursement rates to certain programs.

    I'm fuzzy on this now, but Yes, the Bush folks thought that the states were manipulating their Medicaid funding formulas to draw down a bigger chunk of money from the feds. NYS wasn't affected by that, however.

    The safety net hospitals in NYC were apoplectic over the new HCR bill because of its cuts to the disproportionate share amount. I think they're calmed down now because of the monies they'll receive from having more insured patients. However, NYC hospitals will still have a significant uncompensated care amount.

    Great first diary, and hope to see more from you.

    •  It is important for everyone to give HCR a chance (11+ / 0-)

      The safety net hospitals in NYC were apoplectic over the new HCR bill because of its cuts to the disproportionate share amount. I think they're calmed down now because of the monies they'll receive from having more insured patients

      I am not a big fan of "trust me" but I think that it is important that everyone realize that we have the Obama HHS department handling the new programs for at least 2 more years and hopefully 6 more years. They are NOT going to let the safety net hospitals flounder. Really. If we keep our majorities in Congress we will be in good shape to tweak the laws that help real people.

      Much of life is knowing what to Google

      by JanF on Wed Mar 31, 2010 at 05:16:12 AM PDT

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    •  Great comment. (13+ / 0-)

      I am glad you got into the DSH funding stream. I didn't go into detail about it because I didn't want to put everyone back to sleep. You made it interesting.

      I blog on healthcare issues for Tikkun Daily as Lauren Reichelt.

      by TheFatLadySings on Wed Mar 31, 2010 at 05:20:16 AM PDT

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    •  Change is disturbing (2+ / 0-)
      Recommended by:
      JanF, NCrissieB

      Potentially, change is dangerous. Even well-intentioned change. This is one reason that conservatism will always be with us.

      The safety net hospitals in NYC were apoplectic over the new HCR bill because of its cuts to the disproportionate share amount. I think they're calmed down now because of the monies they'll receive from having more insured patients.

      One can only hope that the re-routing of federal funds will indeed sustain safety net providers, that any flaws or defects will be quickly corrected, and that we will not lose essential providers during the transition period.

      Anecdote: A few years back, I met a man who is one of the pioneer founders of FQHC clinics in California. He was opposed to single payer health care reform, to my horror. When I asked him why, his answer was that the new system, if enacted, could imperil the Medi-Cal wrap-around payments that sustain community health centers. (Wrap-around payments are supplements to ordinary Medicaid reimbursement amounts, which are very low, bringing the total reimbursement up to the actual cost of providing care. FQHCs receive these wrap-arounds because it is understood that a large percentage of their patients will be indigent-- effectively equivalent to "disproportionate share" payments in NYS, I guess.) Point of this story is, he was genuinely concerned that an obviously well-intended change to single payer could inadvertently and fatally damage the institutions that exist to provide care to populations outside of the assumed "norm" of American society.

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