With or without Medicaid expansion, healthcare access at risk

While hospitals in Kentucky now can prepare for increased Medicaid coverage, safety-net facilities in opt-out states must offset the decision to forgo federal Medicaid funding and additional insured patients who can pay their bills.

For many safety nets, that could mean eliminiating services for uninsured patients or hospital workers, Bloomberg reported.

So far, 15 states have refused to expand their Medicaid programs, with five more leaning toward opting out, according to a list from the Advisory Board Company.

In these opt-out states, rural hospitals are particularly vulnerable to the continuing stream of uninsured patients coming through their doors, putting them in danger of shuttering.

With Georgia among those states not participating in the expansion, Grady Health System in Atlanta expects to lose $45 million a year in Medicaid payments, Bloomberg noted. The system has been lobbying the government to allow opt-out states to postpone disproportionate share hospital (DSH) payment cuts to help cushion the financial blow of limited Medicaid coverage.

Reinforcing such provider requests, a recently proposed bill would delay all DSH cuts for two years, FierceHealthFinance reported yesterday.

Meanwhile, as states decide whether to expand Medicaid under the Affordable Care Act, a recent study finds only 43 percent of U.S. physicians, therapists and counselors accept Medicaid patients, according to McClatchy Newspapers. The findings demonstrate that extending Medicaid coverage won't ensure better access to care if almost half of physicians won't see those patients.

"If the current Medicaid acceptance rates hold true for 2014, timely access to care for those relying on Medicaid is likely to become more difficult as enrollees compete for an already inadequate pool of doctors," Kev Coleman, the head of research and data at HealthPocket, told McClatchy.

For more:
- here's the Bloomberg article
- check out the Advisory Board Company list
- read the McClatchy article

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