MHA Press Room

AHA issues data on uncompensated care, Medicare/Medicaid shortfalls

U.S. hospitals provided $36.4 billion in uncompensated care in 2008, according to the latest data from the AHA’s Annual Survey of Hospitals. That’s $2.4 billion more than in 2007.

Underpayment by Medicare and Medicaid to U.S. hospitals reached $32.4 billion in 2008, up from $31.9 billion in 2007 and $3.8 billion in 2000. Medicare reimbursed 91 cents and Medicaid reimbursed 89 cents for every dollar hospitals spent caring for these patients.

The data are summarized in two AHA fact sheets, available online.

Kaiser Issues Two Reports on State Medicaid Coverage of Family Planning and Perinatal Services

The Kaiser Family Foundation has released two related issue briefs that document coverage of family planning services and perinatal services in state Medicaid programs. Both papers highlight selected findings from the 2007/2008 State Survey of Reproductive Health Services Under Medicaid, conducted jointly by the Kaiser Family Foundation and George Washington University School of Public Health and Health Services.

The first brief, State Medicaid Coverage of Family Planning Services, presents state-by-state polices on coverage of key areas in reproductive health for low-income women including contraception, preconception care, screenings for sexually transmitted diseases and coverage within special state Medicaid family planning programs. Federal law requires state Medicaid programs to cover family planning services and supplies for beneficiaries of childbearing age, but states vary considerably in level of coverage of these services. 

The second brief, State Medicaid Coverage of Perinatal Services, examines state Medicaid program policies regarding coverage of pregnancy-related services. The brief details state-level Medicaid eligibility and enrollment policies for pregnant women, as well as scope of coverage for prenatal and screening services, delivery and post-partum care, educational classes, and support services. 

See more information about women’s health care and coverage in the Women’s Health Policy section of the Foundation’s Web site. 

Survey: States cut Medicaid payments as enrollment climbs

Thirty-three states cut or froze Medicaid payment rates for health care providers in Fiscal Year 2009, and at least 39 states are slated to do so in FY 2010, according to a survey released Sept. 30 by the Kaiser Commission on Medicaid and the Uninsured. The number of people on Medicaid and state spending on the program are climbing sharply as a result of the recession, straining state budgets and pressuring officials to curb costs. Medicaid enrollment grew an average 5.4% in FY 2009, the highest rate in six years, and is expected to grow an average 6.6% in FY 2010, state officials said.

“The recession has shown the importance of Medicaid as a safety net for millions of Americans who have lost health coverage when they have lost their jobs,” said Diane Rowland, executive director of the commission. “But it has also shown the challenges for states of maintaining coverage when state revenues drop during times of economic crisis.”

Better Integrated Care for Medicare/Medicaid Dual Eligibles Could Lower Costs

Adults who are dually eligible for both Medicaid and Medicare coverage are among the most chronically ill and costly patients. Most of these eight million "duals" frequently are receiving fragmented, uncoordinated, and ultimately high-cost care, according to a new report.

GAO: Some states using FMAP increase for other purposes

Some states are using a temporary increase in federal Medicaid matching funds to help finance their state budgets, according to a new Government Accountability Office report. The report examines how 16 states and the District of Columbia are using the temporary increase in the Federal Medical Assistance Percentage provided by the American Recovery and Reinvestment Act.

Only two of them did not plan to use some of the FMAP funds to help finance their state budgets, while five states have or plan to use the funds solely for that purpose. They are Arizona, California, Colorado, North Carolina and Ohio.

To date, the states examined have received about $15 billion, or 86%, of their allotted FMAP increase. “The American Hospital Association believes that the temporary FMAP funds should be used by the states to shore-up their Medicaid programs,” said Molly Collins, AHA director for policy. “GAO’s efforts are important in holding states accountable for how these funds are spent.”

Study: Higher Medicaid and CHIP cost-sharing burdensome

Adding even modest cost-sharing requirements for children insured through Medicaid and the Children’s Health Insurance Program could significantly increase the health spending burden faced by families enrolled in those programs, according to a study published June 2 on the Health Affairs Web site. While premium contributions and copayments by families covered by Medicaid or CHIP can lower government spending, policymakers should proceed carefully to avoid large increases in the families’ financial burdens, the study’s authors said.

“Cost sharing has the potential to confront many families with a choice between financial hardship and reductions in their children’s enrollment and use of services,” the study says. However, capping out of pocket medical spending at 5% of family income would help ease the financial burden considerably, while only “modestly” reducing savings in government spending, the study added.

New Brief Analyzes Medicaid and Medicare Spending for Dual Eligible Beneficiaries

A new issue brief from the Kaiser Family Foundation's KCMU analyzes Medicare and Medicaid spending on the "dual eligibles" - those who are simultaneously enrolled in both programs. These seniors and non-elderly people with disabilities are among the nation's most vulnerable populations. They are generally low-income, in poor health and have considerable health care needs, making them one of the most costly populations covered by public health programs.

The brief fills in important gaps in information about dual eligibles by analyzing the demographic and health characteristics of the dual eligible population and their patterns of service utilization and spending under both the Medicare and Medicaid programs. The brief can be viewed online here.

New Analysis Looks at Medicaid Physician Fee Trends From 2003 to 2008

A study published April 28th in a Health Affairs Web exclusive provides the first national and state-by-state update of Medicaid physician fees since 2003. Medicaid has historically reimbursed physicians under fee-for-service at levels below what Medicare and private health insurers would pay for the same services.

The study finds that Medicaid fees grew by more than 15 percent from 2003 to 2008, but fell in real terms because the gains did not keep pace with inflation. Medicaid fees did grow faster than Medicare fees during that period, however, rising from 69 percent of Medicare in 2003 to 72 percent by 2008. Increases were greatest in Medicaid fees for primary care and obstetrical services.

Although findings are based only on Medicaid fee-for-service physician reimbursement, nearly two-thirds of program spending still occurs in the fee-for-service setting. The study was led by Stephen Zuckerman, a senior fellow at the Urban Institute, in partnership with the Foundation's Commission on Medicaid and the Uninsured (KCMU) and the California HealthCare Foundation. The study can be viewed online here.

Health Care and Medicaid - Weathering the Recession

Rising unemployment is leaving millions more Americans without health insurance, creating challenges for those seeking to stabilize coverage and shore up the nation’s health safety net.

In this Perspective article, published March 26 in the New England Journal of Medicine, Diane Rowland, executive vice president of the Kaiser Family Foundation and executive director of the Kaiser Commission on Medicaid and the Uninsured, examines the ongoing recession’s impact on health coverage and state Medicaid programs, which face growing demand and enrollment at the same time that states are confronting severe budget crises.

Despite the recent federal approval of $87 billion in extra help for state Medicaid efforts, many people who have lost their jobs and health coverage will remain ineligible and uninsured.

SCHIP enrollment climbs 4% in 2008

Enrollment in the State Children’s Health Insurance Program rose by 4% in 2008 to 7.4 million children, the Department of Health and Human Services announced recently.

“With unemployment numbers rising and the economy struggling to regain momentum, more and more American families are relying on SCHIP to insure their children get the health coverage they need,” said Acting HHS Secretary Charles Johnson. “It is no surprise that SCHIP enrollment went up in 2008 and we expect this trend to continue well into 2009 if the program is reauthorized.”