With the news of the likely defeat or significant scale back of health reform, I turned my attention to the other part of my job — what is happening in states on Medicaid, CHIP and other issues of interest to children’s hospitals — hoping to find some good news. What I found instead is serious challenges facing children’s hospitals.
In December, we did a survey of children’s hospitals asking what they expected in their 2010 state legislative sessions, many of which start later this month or early next month. The results show that policy priorities for children’s hospitals are more clearly focused on state budget issues. With extreme budget pressures at the state level, states are faced with limited options on how to balance their budgets. Medicaid is often a target because it is one of the largest budget items in many states. Within Medicaid, reimbursement for providers is usually one of the first choices for cuts. From what we have heard from children’s hospitals this has continued in 2009 and more significant cuts are expected in 2010.
According to respondents from 25 children’s hospitals in 18 states, the top three policy issues for children’s hospitals in 2010 are:
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Cuts to Medicaid and CHIP in the state budget: Hospitals in 14 states and D.C. In many cases these are additional cuts since many states have already cut reimbursement to hospitals in the past two years to fill budget shortfalls.
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Provider Taxes: Hospitals in eight states. Many states and hospitals are exploring instituting a provider tax, in many cases it would be a hospital tax, in order to raise the state share for Medicaid and receive more federal funding. This strategy for increasing funding for Medicaid has garnered additional support in the last year due to the federal share increase enacted in the American Recovery and Reinvestment Act.
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Cuts to disproportionate share hospital payments: Hospitals in four states and the District of Columbia. Disproportionate share payments are critical to children’s hospitals because they treat a large number of children covered by Medicaid and Medicaid reimbursement does not cover the cost of care. Loss of this funding would have a significant impact on children’s hospitals.
As you can see from these results, if health reform does not move forward at the federal level, the problem does not go away. In this serious budget crisis how will states be able to continue to support their Medicaid programs to ensure that the children covered are able to access needed health care services. It seems to me discussions in the states this year will necessarily focus on the cost containment strategies needed to balance budgets and not serious discussions of how best to provide health care for children. I hope I am wrong.
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Posted by: Child hospital | 02/08/2010 at 01:22 AM