On that pesky federal Medicaid waiver
By Jim StergiosSeptember 30th, 2008
Kyle Cheney of the State House News Service has been following the discussions on the federal waiver related to the state’s health care reform act (HCRA) and Medicaid programs. (If you do not have a SHNS subscription, get a free one-week trial here because they do great work.) Kyle reports on the press conference held today announcing a deal after numerous extensions provided by the feds as they tried to hammer out a deal that held the federal government harmless and provided the state with the flexibility and resources to make a go of the HCRA.
What the state got was: (1) $21.2 billion over three years in state and federal match ($10.6 in fed and $10.6 in state funding), including support for the HCRA; (2) maintenance of the 300% federal poverty level coverage in the HCRA; and (3) flexibility to use the money over a three-year period rather than on a year-to-year basis.
The $21.2 billion number is $1.8 billion less than the state had asked for, but $4.3 billion more than the last three-year waiver.
The deal was in fact a “compromise.”
- The $4.3 billion, from what we can make out, stays in line with the feds’ desire for federal budget/waiver neutrality. Cost of health care increases seem to be the reason for the increase.
- The Safety Net Care Pool (SNCP) cap was raised a bit from $1.3 billion to $1.5 billion a year based on adjustments for mistakes in the previous waiver’s calculations.
Unlike Secretary Bigby’s representation at the press conference, my information is that there was a good long dispute over the Section 122 payments to Boston Medical Center and Cambridge Health Alliance. This is just hearsay (so don’t hold me or anyone to it), but word is that
- The BMC and CHA payments will be phased down over the next three years from $75 million to $50 million to $25 million. That’s well below the $180 million in special payments going to these admittedly very important institutions.
- The total SNCP cap of $4.5 billion (over three years) will be made available to the state in year one and it will have broad flexibility over how/when to use those funds within the programs under the SNCP. Look for a food fight over how that cap gets distributed. My guess is that there will be lots of moaning if someone else’s ox gets gored to ensure that BMC and CHA are held harmless.
The solution? Distribute any special payments to all hospitals serving the poor based on the data. Do not single out specific institutions. In other words, be fair. Pretty simple, no?
Again, this is just at the level of hearsay. Come back to this space for more soon.
Entry Filed under: Healthcare, News
3 Comments Add your own
1. Dennis D. Keefe | October 1st, 2008 at 1:11 pm
Jim, in the words of Ronald Reagan “there you go again.”
We have previously pointed out the errors in your analysis and how several Massachusetts safety net health care systems stand apart from the rest of the hospital sector for their role in caring for low-income and uninsured government health care dependent populations.
Now we are confronted with the limited value of hearsay and the fact you don’t want to be held accountable for the things you publish here. That speaks volumes about the lack of substance broadcast recently by you and the Pioneer Institute. It is a troubling trend and is more suggestive of ideological banter than of the standards expected from a public policy institute.
You are simply wrong on the facts about payments for Cambridge Health Alliance and Boston Medical Center and you impugn Secretary Bigby’s integrity and credibility. We are unaware of any new agreement on our future funding levels and the figures reported are not accurate (nor adequate for that matter) – according to the sources directly involved in the state-federal negotiations and whose information has been entirely consistent throughout this process.
A few facts are worth repeating. Based on the last available full year of data (2007), Cambridge Health Alliance provided 34 times the health care to the uninsured compared to the community hospital average (based on Uncompensated Care Pool costs) and 14 times the health care to Medicaid/Commonwealth Care patients compared to the community hospital average. Cambridge Health Alliance provided nearly one-third of the inpatient mental health care in the state to the uninsured or 23 times the average hospital in Massachusetts. These are but a few of the reasons that CHA stands apart and has required additional financial support to maintain a large volume of essential but poorly reimbursed health care services like the growing demands for primary care and mental health care under health care reform.
Ironically, we could actually support your ultimate idea to distribute special payments to all hospitals serving the poor based on the data. We don’t believe, however, it would have the result you envision and would unduly harm some very good health care facilities.
2. Jim Stergios | October 1st, 2008 at 2:52 pm
Dennis: Thanks for your comment. No ideology here at all, but you know that and that is why thou protesteth so much. I state clearly in my post that what I have heard is altogether hearsay — so I may very well be wrong. And I may be very wrong. I always admit this when I do not have a piece of paper or data in front of me that I can rely on.
I’ll glide over the self-serving suggestion that you have provided all sorts of data to undermine my original argument. I suggested to you an exchange on the issue and you suggested back that you have been having this argument for a long time and that in fact data would not help come to a general agreement on the facts.
In regard to your closing: “Ironically, we could actually support your ultimate idea to distribute special payments to all hospitals serving the poor based on the data. We don’t believe, however, it would have the result you envision and would unduly harm some very good health care facilities.” Let me say again very clearly — if the data takes us to the place where BMC and CHA merit more support and the other urban hospitals serving the same poor populations deserve less, as you seem to imply, then I would follow the data.
If you are implying that BMC and CHA and all the other urban hospitals deserve money, that is a different argument, and I would suggest that you stop investing in medical technology and start investing in buying some old machinery from the Mint.
3. mischievous blogger | October 2nd, 2008 at 4:05 pm
why would mr.keefe reply defensively if, as he’s suggesting, there’s nothing to defend.
transference doesn’t make it any less transparent. makes it more so.
it is not personal.
Leave a Comment
Some HTML allowed:
<a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <strike> <strong>
Subscribe to the comments via RSS Feed