Hospitals seek clarification on Medicaid expansion

The American Hospital Association is asking U.S. Department of Health & Human Services Secretary Kathleen Sebelius to clarify how the Supreme Court ruling upholding healthcare reform will affect Medicaid payments to hospitals.

In a letter dated Aug. 20, the AHA zeroes in on the court's decision that the expansion of Medicaid under the Patient Protection and Affordable Care Act cannot be enforced by withholding Medicaid funds from nonparticipating states.

The AHA asked for clarification in a dozen areas, including:

  • Whether patients with incomes between 100 percent and 138 percent of the federal poverty level are eligible for subsidies through an insurance exchange.
  • Whether states can expand Medicaid coverage to certain individuals, such as single, childless adults and parents of Medicaid patients, or phase in coverage over several years.
  • Whether HHS will consider ways to help states manage patients currently eligible for but not enrolled in Medicaid who might be enrolled under the new mandate.
  • How to minimize the administrative burden of patients "churning" between Medicaid and exchanges
  • When CMS will issue regulations related to reduced Medicare disproportionate share hospital (DSH) payments.

The letter is signed by Rich Umbdenstock, president and CEO of the organization representing 5,000 hospitals and 42,000 individual members.

Budget directors in six states surveyed earlier this summer by the Government Accountability Office expressed concern about the costs and technicalities involved in expanding Medicaid under the Affordable Care Act. The budget officials in Colorado, Georgia, Iowa, Minnesota, New York and Virginia also said they hadn't received enough guidance on the change from CMS.

The National Governors Association and the National Association of Medicaid Directors also have requested clarification from HHS on Medicaid expansion.

The governors group asked about options and federal assistance for states that decide against expanding Medicaid coverage, among other issues. The Medicaid directors group wanted better definition of newly eligible individuals in states that already expanded some coverage to additional groups.

To learn more:
- here's the AHA letter (.pdf)

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