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MACPAC: Medicaid DSH Payments Not Always Reaching Targeted Providers

In many cases, Medicaid disproportionate share payments (Medicaid DSH) are being made to hospitals that do not necessarily serve especially large proportions of Medicaid and other low-income patients.

So concludes a new report from The Medicaid and CHIP Payment and Access Commission (MACPAC), is a non-partisan legislative branch agency that performs policy and data analysis and makes recommendations to Congress, the Secretary of the U.S. Department of Health and Human Services, and the states on issues affecting Medicaid and the State Children’s Health Insurance Program (CHIP).

macpacAccording to a new MACPAC report,

Medicaid DSH payments provide substantial support to safety-net hospitals by helping to offset uncompensated care costs for Medicaid and uninsured patients. In 2014, Medicaid made a total of $18 billion in DSH payments ($8 billion in state funds and $10 billion in federal funds). About half of all U.S. hospitals receive such payments, with most going to hospitals that serve a particularly high share of Medicaid and other low-income patients, known as deemed DSH hospitals. But more than one-third of DSH payments are made to hospitals that do not meet this standard.

To remedy this problem, MACPAC recommends more and better data collection, noting that

The current variation in state DSH allotments stems from the variations that existed in state DSH spending in 1992.

Medicaid DSH has long been a subject of great interest to the nation’s private safety-net hospitals because, serving so many Medicaid and low-income patients, they are the very providers for which Medicaid DSH payments have always been intended.

The MACPAC analysis Report to Congress on Medicaid Disproportionate Share Hospital Payments covers a broad range of Medicaid DSH-related issues. Find it here, on the MACPAC web site.

MACPAC Reports to Congress

The Medicaid and CHIP Payment and Access Commission (MACPAC) has released its second of two 2015 reports to Congress on Medicaid and the Children’s Health Insurance Program (CHIP).

In the report, the agency looks at the role of Medicaid in providing behavioral health services; examines Medicaid coverage of dental services for adults; contemplates the intersection between Medicaid and child welfare; and considers whether Delivery System Reform Incentive Payment (DSRIP) programs are a legitimate means of fostering health care delivery reform or have become just a means of states’ supplementing the Medicaid payments they make to providers.

Find a summary of the MACPAC report and a link to the complete report here.

Chairmen Seek Ideas for Improving Medicaid

The chairmen of four key congressional committees have written to the Medicaid and CHIP Payment and Access Commission (MACPAC) seeking “assistance in developing policy options to ensure the sustainability of the Medicaid program so it can continue to provide essential coverage and services to vulnerable populations.”

Congress ChamberThe letter, signed by the chairmen of the Senate Finance Committee, Senate Committee on Health, Education, Labor, and Pensions, the House Energy and Commerce Committee, and the Energy and Commerce Committee’s Health Subcommittee, asks MACPAC to “analyze and evaluate” financing reforms to reduce government spending; past reform proposals; ways to give states greater flexibility; options for Medicaid block grants; and other potential changes.

See the letter here.

MACPAC Looks at Value-Based Purchasing in Medicaid

At a recent meeting of the Medicaid and CHIP Payment and Access Commission (MACPAC), the agency’s staff made a presentation on how different states are pursuing value-based purchasing in their Medicaid programs.

The presentation focused on current efforts in three states: Connecticut, Maryland, and Oklahoma, describing the policy approach those states have taken, the models they employ, the implementation challenges they have faced, and how they evaluate the effectiveness of their efforts.

Because they care for so many Medicaid patients, the nation’s private safety-net hospitals have a special interest in new approaches to Medicaid payment policy.

Find the MACPAC presentation here.

MACPAC Looks at DSRIP

The legislative branch agency that advises Congress, the Secretary of the U.S. Department of Health and state governments on Medicaid and Children’s Health Insurance Program (CHIP) issues recently took a look at a relatively new type of supplemental Medicaid funding.

The Medicaid and CHIP Payment and Access Commission (MACPAC) is examining Delivery System Reform Incentive Payment Programs (DSRIP), which it describes as

…a new type of supplemental payment that provide incentive payments for hospitals and other providers to undertake delivery system transformation efforts. Currently operating in California, Texas, Massachusetts, Kansas, New Jersey, and New York, DSRIP projects are led by hospitals, but often involve collaborations with non-hospital providers. They generally fall into two categories—infrastructure development and care innovation and redesign. Payments are tied to corresponding improvements in health outcomes for Medicaid enrollees and the uninsured.

MACPAC’s staff delivered a presentation on DSRIP to commission members. See that presentation here.

 

MACPAC Looks at Medicaid, CHIP Issues

The Medicaid and CHIP Payment and Access Commission (MACPAC), the independent, non-partisan federal agency that advises Congress on the Medicaid and CHIP programs, met in Washington, D.C. recently to examine a number of issues under its purview.

During two days of meetings, MACPAC heard staff presentations on the status of Medicaid expansion, sites of care for the delivery of Medicaid services, Medicaid eligibility and enrollment issues, Medicaid behavioral health populations, and more.

See these and other presentations here, on MACPAC ‘s web site.

New Medicaid Enrollees Must Renew Coverage

People whose enrollment in Medicaid in the past year was made possible by Affordable Care Act eligibility expansions are required by the health care reform law to renew their eligibility annually.

But many do not know this, according to focus groups performed on behalf of the Medicare and CHIP Payment and Access Commission (MACPAC).

iStock_000008064653XSmallAs a result, some of these recipients could find themselves without coverage when they seek care in the near future – a situation that could leave some with significant medical bills while leaving providers unpaid for care they have delivered.

Private safety-net hospitals would be especially vulnerable to such unpaid charges because they serve so many low-income and Medicaid patients.

Learn more about this issue and its implications in this CQ HealthBeat article presented by the Commonwealth Fund.

MACPAC Looks at Medicaid, CHIP Issues

The non-partisan federal agency charged with advising Congress, the Department of Health and Human Services, and the states on matters involving Medicaid and the Children’s Health Insurance Program (CHIP) met last week in Washington, D.C.

The Medicaid and CHIP Payment and Access Commission (MACPAC) addressed a number of CHIP-related issues during its September 18-19 meetings, including the future of the program, its funding, state experiences with CHIP changes, and consumer protections.

macpacMACPAC also looked at a variety of Medicaid issues, including state Medicaid expansions through premium assistance, enrollment so far in 2014, the Centers for Medicare & Medicaid Services’ Medicaid program integrity plan, early experiences of new enrollees, and future reductions in Medicaid disproportionate share payments (Medicaid DSH).

CHIP and Medicaid are especially important for the nation’s private safety-net hospitals because they serve so many low-income patients.  The National Association of Urban Hospitals (NAUH) has been particularly active in advocating delays in Affordable Care Act-mandated reductions in Medicaid DSH payments.

For a summary of the commission’s deliberations, see this CQ HealthBeat article presented by the Commonwealth Fund.

To see the presentations made during the two-day session go here, to MACPAC’s web site.

Medicaid Patients are High Users But Not Abusers of ER Services, Report Says

Medicaid patients use hospital emergency rooms more frequently than privately insured and uninsured patients but are not overusing or abusing ER services.

So says the Medicaid and CHIP Payment and Access Commission (MACPAC) in a recent report that contradicts the widely held belief that Medicaid patients abuse hospital ER services.

According to “Revisiting Emergency Department Use in Medicaid,” “Higher ED use among Medicaid enrollees is explained mostly by the higher rates and more severe cases of chronic disease and disability they experience relative to those who are privately insured and uninsured.”

In addition, MACPAC found, “High ED use also can be a sign of poor access to primary, specialty, dental, and outpatient mental health care in other settings.”  In 2012, for example, “…about one in four adult Medicaid enrollees who reported a recent visit to the ED went there because of difficulty accessing another provider, not because of a serious health problem.”

macpacMACPAC also concluded that “The majority of ED visits by non-elderly Medicaid patients are for urgent symptoms and serious medical problems that require prompt medical attention…Non-urgent visits account for just 10 percent of all Medicaid-covered ED visits for non-elderly patients, a proportion comparable to that of privately insured patients.”

Private safety-net hospitals serve far more Medicaid patients than the typical acute-care hospital and therefore face far greater challenges in meeting these patients’ needs.

Learn more about MACPAC’s findings in “Revisiting Emergency Department Use in Medicaid,” which can be found here.

MACPAC Recommends Steps to Ensure Continuity of Care

Citing income volatility among low-income Americans, the federal agency charged with analyzing Medicaid and the Children’s Health Insurance Program (CHIP) has recommended that Congress adopt measures to ensure that low-income Americans retain health insurance as their income fluctuates above and below the federal poverty level.

In its March report to Congress, MACPAC (the Medicaid and CHIP Payment and Access Commission) recommends that Congress empower states to extend coverage to eligible adults for an entire year to ensure that as those adults become eligible for Medicaid, lose Medicaid eligibility as their income rises, and then become eligible again because of unemployment or illness, they can maintain continuity of coverage and care.

macpacMACPAC also recommends that Congress extend the current transitional medical assistance program so low-income parents who move into the workforce do not immediately lose their Medicaid coverage and that it eliminate the waiting period for CHIP eligibility and prohibit CHIP premiums for children from families whose income is less than 150 percent of the federal poverty level.

MACPAC is a non-partisan federal agency charged with providing policy and data analysis to Congress on Medicaid and CHIP and making recommendations to Congress, the Secretary of the U.S. Department of Health and Human Services, and the states on a wide range of issues affecting these programs.

For more information about MACPAC’s March 2014 report and recommendations, see this MACPAC news release or find the entire report here.