Missouri’s safety net healthcare providers are seeing increased numbers of uninsured patients and are incurring new financial strains as a result of the changes made to Missouri’s Medicaid system in 2005.
New reports from the Missouri Foundation for Health reveal how Missouri’s hospitals and Federally Qualified Health Centers pass on to those with private insurance their increasing cost of providing care to the uninsured.
“These reports highlight the fact that while the 2005 changes to Missouri’s Medicaid system may have reduced that line item in the state budget, the need to provide the services did not go down,” said Ryan Barker, MFH policy analyst. “As a result, the costs of providing care to those that lost coverage was picked up through more local tax dollars, reduced services in other areas, and/or increasing the cost of care provided to privately insured patients.”
The reports examined the impact of the 2005 changes to Missouri’s Medicaid/SCHIP program on the state’s safety net healthcare providers. They were compiled by the MFH in conjunction with the Health Care Foundation of Greater Kansas City and in cooperation with the Missouri Hospital Association and the Missouri Primary Care Association.
The report on Missouri’s hospitals examined the impact on hospitals based on ownership category (public, for-profit, and not-for-profit), their geography - dividing Missouri into four regions: Kansas City Metropolitan Statistical Area, St. Louis MSA, other urban MSAs, and rural - and other factors.
“The 2005 Medicaid cuts precipitated a significant shift in the state’s health safety net - from the state and federal government to individuals with commercial insurance and self-pay patients,” said Dwight Fine, senior vice president of health policy for the Missouri Hospital Association. “The study verifies that Medicaid coverage reductions correlate with an immediate increase in emergency department utilization for care and a decline in health status caused by the elimination of a primary care venue.”
The report on Missouri FQHCs reviewed data for 17 centers during 2004 and 2005 and a total of 19 FQHCs for 2006. It examined data such as the income level, age, and insurance source of FQHC patients as well as the sources of revenue for Missouri’s FQHCs.
“Health coverage and adequate reimbursement, especially through Medicaid, are absolutely critical for the viability of safety net providers such as Community Health Centers,” said Joseph Pierle, CEO of the Missouri Primary Care Association. “There is no doubt that Community Health Centers have struggled to maintain capacity to take care of growing numbers of low-income under and uninsured individuals in every region of the state.”
Among the key data highlighted in the reports:
• Both hospitals and FQHCs saw an increase in the number of uninsured patients, corresponding to a decrease in the number of patients with Medicaid/SCHIP coverage.
• FQHCs saw a drop in Medicaid revenue after the 2005 changes were enacted. This loss in Medicaid funding was made up for with funding from government grants and contracts, as well as other sources, resulting in communities effectively picking up more of the tab for the cost of care for the uninsured.
• Hospitals saw an increase in charity care cases and the amount of bad debt. Hospitals offset their increased costs by increasing the amount they charged private insurance.