Safety-Net Providers in a Post-Reform World:Medicaid Matters

Julia ParadiseAssociate Director

Kaiser Commission on Medicaid and the Uninsured

for

Health Policy, Law, and Ethics ForumGeorge Washington University School of Public Health and Health Services

Wake Forest University School of Law and Center for Bioethics, Health and Society

October 17, 2012

FIGURE 2

The majority of health center and public hospital patients are uninsured people and Medicaid beneficiaries

SOURCE: Public hospital data from America’s Safety Net Hospitals and Health Systems 2010: Results of the Annual NAPH Hospital Characteristics Survey, National Association of Public Hospitals and Health Systems, May 2012. Health center data from 2010 UDS, HRSA.

Health center patients Public hospital discharges

38%18%

39%

36%

14%

19%

8%

25%

3% 3%Other

Medicare

Private

Medicaid/Other Pub-lic

Uninsured

Distribution by payer source:

FIGURE 1

FIGURE 3

Medicaid is a major source of financing for safety-net providers

Private27%

Medicare21%

Uninsured4% Other

3%

Medicaid35%

State/Local Subsidies11%

Total = $47 billion

SOURCE: Public hospital data from America’s Safety Net Hospitals and Health Systems 2010: Results of the Annual NAPH Hospital Characteristics Survey, National Association of Public Hospitals and Health Systems, May 2012. Health center data from 2010 Uniform Data System (UDS), HRSA.

Medicaid38%

State/Local/ Other15%Private

7%Medicare

6%

Federal Grants23%

Self-Pay9%

Other Public3%

Chart Title

Total = $12.7 billion

Public Hospital Net Revenues by Payer, 2010

Health Center Revenues by Source, 2010

FIGURE 2

FIGURE 4

Key Medicaid decisions will affect what safety-net providers can achieve under health reform

Implementation of Medicaid expansion?

Scope of Medicaid benchmark benefits

Medicaid outreach and enrollment

effort

Allocation, targeting of Medicaid DSH

Adequacy of Medicaid provider

payment rates

SAFETY-NETPROVIDERS

FIGURE 3