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Emanuel Medical Center in rural Georgia racks up greater than $350,000 a month in losses offering well being look after low-income and uninsured sufferers. But a brand new state funding proposal might considerably scale back these deficits, not only for the 66-bed Swainsboro facility however for many rural hospitals in Georgia, in response to state Medicaid officers.
It’s not Medicaid growth, which Georgia Republican leaders have rejected. Instead, the state Department of Community Health is utilizing an under-the-radar Medicaid funding alternative that has been quickly taken up by greater than 35 states — together with many of the states which have expanded the federal government insurance coverage program.
The further federal cash comes by way of an obscure, difficult mechanism referred to as “directed payments” — out there just for states that rent well being insurers to ship companies for Medicaid.
In 2020, these particular funding streams, that are authorised by federal well being officers, despatched greater than $25 billion to states, in response to the Medicaid and CHIP Payment and Access Commission (MACPAC), which advises Congress.
The Centers for Medicare & Medicaid Services, when requested for an up to date complete, referred KHN to particular person states for his or her spending figures. “CMS has not publicly printed complete spending associated to state directed funds,’’ stated company spokesperson Bruce Alexander.
But the Government Accountability Office, Congress’ watchdog company, and MACPAC say federal well being officers ought to do extra to watch directed funds and consider whether or not states meet this system’s targets, which embrace improved entry and high quality of care. More transparency is required, these businesses stated.
A MACPAC report final yr discovered that fewer than 25% of directed cost plans operating for a minimum of a yr had evaluations out there for evaluation.
Federal well being officers “are getting a lot of questions” on directed funds from GAO and MACPAC, stated Debra Lipson, a senior fellow at consulting agency Mathematica, which has studied the difficulty. “It’s a lot of money.”
CMS hasn’t but launched stories on high quality metrics for this system, Lipson added.
Alexander, the CMS spokesperson, stated the company “takes our role in oversight and transparency seriously, and we are working collaboratively with our federal and state partners to improve our oversight and transparency” of directed funds.
Medicaid is the federal government medical insurance program for low-income and disabled sufferers. It’s collectively financed by the states and the federal authorities.
CMS launched the directed funds program in 2016. Georgia officers estimated the state will web $1 billion in federal funds this fiscal yr for hospitals and different medical suppliers by way of its directed cost applications.
California estimates it introduced in additional than $6 billion simply final yr in new federal funds by way of directed funds. Arizona obtained $4.3 billion between 2018 and 2022. Florida netted greater than $1 billion over a 12-month interval ending in September.
This particular Medicaid funding might not directly assist sufferers by strengthening monetary stability for hospitals, together with providing the potential for capital enhancements from the added money infusions.
But affected person advocates and Democratic lawmakers in Georgia stated offering insurance coverage protection for the medical wants of the uninsured by adopting Medicaid growth is extra pressing. Hospitals, like Emanuel Medical Center, would profit from Medicaid reimbursements for sufferers who now usually rack up unpaid payments for care.
The uninsured “are not going to get preventive care, and that drives up health care costs,” stated state Sen. Elena Parent, an Atlanta-area Democrat. “The state should have expanded Medicaid.”
That growth shouldn’t be going to occur in Georgia within the brief run, as Republican Gov. Brian Kemp is about to launch new limits on Medicaid enrollment for low-income adults, with work necessities hooked up.
Under directed funds, added funding for hospitals and different Medicaid medical suppliers flows by way of completely different avenues, together with minimal charges for companies, a common reimbursement enhance, and pay hikes primarily based on high quality of care.
Payments are primarily based on the amount of companies delivered. If one hospital served extra Medicaid sufferers than one other, its reimbursements could be larger, Lipson stated.
“CMS initially was surprised by the volume of states’ directed payment proposals,” stated Lipson. Some states have 25 or extra, she added. They should be renewed yearly. Often states finance their portion by way of hospital assessments or cash transferred from public funds, reminiscent of hospital authorities, county governments, and state businesses.
Georgia has 5 such directed cost plans. Their targets embrace boosting Medicaid pay for hospitals and medical doctors, strengthening the well being care workforce, and enhancing well being outcomes and fairness, stated Caylee Noggle, commissioner of the state Department of Community Health, which runs Medicaid in Georgia.
Grady Memorial Hospital in Atlanta, a big safety-net supplier, stated it expects to achieve $139 million throughout 4 of the Georgia applications.
“It’s a tremendous benefit for us,” stated Ryan Loke, Grady’s chief well being coverage officer. “Without this money, Grady would be in a lot worse position.”
Grady is seeing extra Medicaid and uninsured sufferers who previously used close by Atlanta Medical Center, which closed final yr.
State Sen. Ben Watson, a doctor and Savannah-area Republican, identified that such safety-net hospitals, which serve a big portion of people that lack well being protection, are getting larger pay by way of Medicaid directed funds, thus serving to them cowl some losses.
Georgia plans to make use of these funding streams as a base for extending further assist to rural hospitals.
With the additional funds, Grady and different hospitals will strategy or attain their regular funding restrict for hospitals that serve a “disproportionate share” of indigent sufferers. The state would take about $100 million of this extra cash and ship it to rural hospitals.
The Georgia Hospital Association stated the directed cost cash is useful however received’t cowl prices of charity look after the uninsured.
“They’re not looking at [hospitals’] bad debt,” stated Anna Adams, an government with the group. “An insured patient is a healthier patient. We’d love to see as many people covered as possible.”
Officials at rural hospitals in Georgia, in the meantime, are wanting ahead to the projected increase in Medicaid funds.
“It’s going to put cash in the coffers of rural hospitals that are struggling,” stated Jimmy Lewis, CEO of HomeTown Health, an affiliation of rural hospitals within the state.
Damien Scott, CEO of Emanuel Medical Center, stated he’s “cautiously optimistic” concerning the coming allocation. On his want checklist: attracting a pediatrician to his county — it has none at present — and gaining the house to maneuver the hospital’s lone MRI machine from a truck into the hospital constructing.
As it’s, he stated, “we struggle every month for our survival.”