Bill Considine has supported efforts to expand Medicaid to provide health coverage to more uninsured adults across the state.
But now the leader of Akron Children’s Hospital is concerned expansion of the state-run public insurance program to help poor adults might unintentionally end up harming hospitals that care for young patients.
“The expansion really wasn’t going to do anything for kids, but it made sense for the adult population and we support that,” Considine said. “ … We do so with the understanding, too, that the 1.2 million kids who are now on Medicaid won’t be hurt by the expansion.”
The governor’s original budget proposal that included Medicaid expansion also had payment cuts for hospitals, said Nick Lashutka, president of the Ohio Children’s Hospital Association, which represents six pediatric hospitals across the state. Those reductions went away when lawmakers rejected plans to expand Medicaid eligibility to poor adults.
But then a state legislative panel gave the go-ahead last month for Gov. John Kasich’s administration to spend federal money to expand Medicaid eligibility beginning in 2014.
Barring a court ruling reversing the decision by the Controlling Board, the state is moving forward with boosting Medicaid eligibility for adults to 138 percent of the federal poverty level, or $15,856 for an individual.
Currently, Ohio adults without children are ineligible for Medicaid, except for low-income disabled residents. In many low-income families, children qualify for coverage but their parents don’t.
Children’s hospitals are concerned the Medicaid cuts that originally were included in the state budget are back now that Medicaid expansion is moving forward, Lashutka said.
A proposed 5 percent reduction in Medicaid inpatient payment rates would result in a nearly $35.4 million loss for Ohio’s six pediatric hospitals through July 1, 2015, he said.
Pediatric hospitals take the biggest hit.
According to the Ohio Hospital Association, the Ohio Department of Medicaid estimates the inpatient hospital payment rate cuts would equate to a savings of about $96 million.
In addition, a proposed change to the formula to help hospitals pay for building and other capital projects could result in another $11.3 million in lost revenues for pediatric hospitals, according to the Ohio Children’s Hospital Association.
Slightly more than half the patients at children’s hospitals statewide are covered by Medicaid.
Though hospitals with mostly adult patients could gain more Medicaid patients with expansion, children’s hospitals likely won’t see the same benefit, Considine said. That’s because it’s already much easier for children to qualify for coverage.
The financial requirements for children to be eligible for Medicaid through the State Children’s Health Insurance Program is 200 percent of the federal poverty level.
“There is no real benefit to children’s hospitals,” Lashutka said. “We’re simply asking that we not be financially harmed as a result of expansion.”
Officials with the Ohio Department of Medicaid said the department is working to implement the inpatient payment rate reductions and adjustments to the capital payments that were part of the governor’s original budget, but details haven’t been finalized.
The state also recently adjusted its Medicaid payment methods to bump up some reimbursements for pediatric care, according to the department.
The state expects children’s hospitals to see more Medicaid patients from the “woodworking effect” of children who already were qualified for the program actually enrolling in the program because of federal health-care reform.
In addition, pediatric hospitals should see more Medicaid coverage for adults they treat with congenital heart defects or chronic illnesses that begin in childhood, according to the Medicaid office.
Lashutka said the children’s hospital association is working with the state and the Ohio Hospital Association to see whether a solution can be found to limit the potential financial impact on pediatric facilities.
“Our folks have been strong supporters of the expansion of Medicaid for adults from the beginning, as long as it doesn’t hurt children or children’s hospitals,” Lashutka said. “There’s good data that a healthy family helps to improve the health of the child. … This is morally the right thing to do.”
Cheryl Powell can be reached at 330-996-3902 or email@example.com. Follow Powell on Twitter at twitter.com/abjcherylpowell.