Newspaper article St Louis Post-Dispatch (MO)

Hospitals Warn of Financial Fallout over Missouri's Changes to Medicaid Managed Care Payments

Newspaper article St Louis Post-Dispatch (MO)

Hospitals Warn of Financial Fallout over Missouri's Changes to Medicaid Managed Care Payments

Article excerpt

Missouri is changing the terms for how health care providers are paid after caring for certain Medicaid recipients, a move some rural hospitals warn could lead to financial losses.

If providers do not come in-network with the three insurance companies contracted by the state to provide coverage to certain Medicaid recipients, providers will be paid 10 percent less than they're used to. The change went into effect Sunday.

Providers sounded off at a public hearing last week in Jefferson City. The public meeting was held by the Department of Social Services, which oversees the state's Medicaid program.

"We're truly in a situation where every dollar matters," Mat Reidhead, a board member of Hermann Area District Hospital, said at the hearing.

Tim Wolters, director of reimbursement for Citizens Memorial Hospital, a rural facility north of Springfield, told the Post-Dispatch the decision could create a potentially dire financial situation for hospitals.

"Medicaid overall is a huge payer for us, and if we lost 10 percent that would probably be $1 million dollars off our bottom line, and our bottom line is about $1.6 million," Wolters said.

Financial issues are among the stresses on rural hospitals. More than 120 rural hospitals have closed nationwide since 2005, according to the North Carolina Rural Health Research and Policy Analysis Center at the University of North Carolina at Chapel Hill.

The Department of Social Services said the intent of the change was to increase provider participation in managed care plans, but some physicians warned that it would discourage private practices from accepting Medicaid, which typically is reimbursed at low rates, typically lower than traditional employer-based commercial coverage.

"I think it's very serious," Dr. Randall Haight, vice president of Capital Regional Medical Center in Jefferson City, told the Post-Dispatch. "It will reduce access to physicians that are willing and able to care for the Medicaid population."

Without private practitioners willing to see Medicaid patients, Haight fears Medicaid patients may turn to emergency rooms.

Typically, providers and insurance companies negotiate pricing terms for providing care to Medicaid patients. …

Search by... Author
Show... All Results Primary Sources Peer-reviewed

Oops!

An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.