Hospitals that serve Medicaid and uninsured populations often experience funding shortfalls that can overwhelm facilities and compromise the care of a community’s most vulnerable populations. Innovative Medicaid financing programs for hospitals can help fund health care services for those who need them most and shore up finances for these facilities over time.
Medicaid populations are among the most vulnerable when it comes to accessing health care, and since the beginning of the pandemic, the number of Medicaid patients nationwide continues to grow. Medicaid expansion has caused many hospitals–even those with small numbers of Medicaid patients historically–to review and evaluate their finances as population needs outstrip available resources. Urgent care, emergency rooms, and inpatient beds are maxed out in many urban and suburban hospitals that didn’t have these issues 10 years ago.
Care and funding gaps, further exacerbated by COVID-19, have developed; hospital finance executives, along with states, and other providers are looking for solutions.
The good news is that financing solutions do exist that can bridge funding gaps. Innovative funding programs have been designed and implemented for hospitals in many states around the country.
Low Medicaid reimbursements for hospitals combined with increasing Medicaid populations can cause many challenges for hospitals.
Chronic health conditions as well as housing and food insecurity and lack of transportation can make treating Medicaid and uninsured populations more difficult.
Thoughtful and meaningful Medicaid financing programs can be helpful in addressing these clinical needs and social determinants of health.
Bringing supplemental funding to bear on emergent issues requires out-of-the-box thinking combined with technical, policy, and political know-how so that hospitals have what they need to help those who need their care.
New Jersey is a recent success story, having obtained CMS approval for the County Option Hospital Fee Pilot Program Act which has allowed hospitals, counties, and the State to work together to achieve significant results that will deliver over $400 million in its first year to more than 40 hospitals. The supplemental funding provides hospitals with a new revenue stream to enable increased access and higher-quality care for Medicaid enrollees.
Navigating the complexities of program design, CMS approval and implementation requires thorough preparation and a deep understanding of hospital Medicaid financing. While the process can be complex, addressing the following basics is a good place to start:
Most hospitals—not just safety-nets—are facing growing pressure to take care of more patients, improve healthy equity, and deliver better quality outcomes. In many cases, the financial, clinical, and social resources can’t keep up with the demands of Medicaid expansion and the increase in uninsured populations.
New hospital Medicaid financing and supplemental payment concepts can bridge the gap and provide relief to affected hospitals and the communities they serve. They take time and expertise to design, plan, and launch, but the results can create stronger hospitals, easier access to care, and healthier communities.
If you’d like to learn more about our Medicaid financing services, please contact the Medicaid financing experts at Sellers Dorsey.