Sign-on for Equity for the Uninsured and Safety-Net Providers
The current way that New York State pays hospitals for taking care of people with no insurance is outdated, with almost no accountability for where the money goes and what it pays for. CPHS believes that the $847 million a year in Charity Care funds for hospitals should directly pay for the care of uninsured patients. There are hospitals that provide a lot of this care – and others that provide very little. Money should flow based on which hospitals provide the care. With the passage of federal health reform – the Affordable Care Act -- we need to change our current way of using the federal matching dollars in this program (DSH). If New York does not change, we could lose federal dollars.
CPHS, and an advisory group, worked with a Professor from Boston University to track the current way charity care dollars are given out. We also developed a proposal for a fairer and more accountable system for hospitals to be paid for uninsured care. The most important principle we used is that the money follows the patient – it goes to hospitals to pay for care of the uninsured. The second principle is those hospitals which provide a greater percent of uninsured care would get a progressive bump in the dollars they receive. These are the steps we proposed as the changes that are needed:
* The first step was figuring out the median statewide Medicaid reimbursement rate.
* The second step is to add to this median rate the regional costs for things like salaries and then to add more for the care of sicker patients.
* The third step is to add more dollars on a progressive scale for hospitals that treat a higher percent of uninsured patients.
* The final step occurs if the federal DSH dollars are reduced; we proposed a way of combining the current pools to fund public and private hospitals. This is very important because the 21 public hospitals in the state provide the lions share of services for the uninsured.
In the past, there have been efforts to adopt a new charity care system with little success. It is not only morally important to make these changes; it is also required by federal law. Even with the law on our side, convincing hospital associations and some of their allies may be very difficult. The more support we can gather for these proposals, the better the chance that we can influence two of the committees of the Medicaid Redesign Team that will be looking at Charity Care and access for the uninsured – the Health Disparities and Payment Reform Committees. Any changes in charity care must go through the state legislature so that we will also be bringing these issues to them.
In a separate proposal, CPHS addresses additional funding for safety-net hospitals that provide a high proportion of care for Medicaid patients but do not provide as much care for the uninsured. To ensure that these hospitals do not lose money as a result of our charity care recommendations, we propose a special increase in the Medicaid reimbursement rate to cover potential funding shortfall. We also propose an increase in the dollar amount of the Charity Care pool which funds community health centers for the care of the uninsured. This pool is much smaller than the hospital pool, even though health centers report the number of uninsured patients/visits and get paid for the care of the uninsured. The Health Centers/D&TC’s provide services for large number of uninsured patients.
Please support these proposals and allow us to list your name, your organization or your union's name as supporters of this call for equity.
*Endorsers to date (9/27/11)
Arab American Family Support Center
Asian & Pacific Islander Coalition on HIV/AID, Inc.
Brooklyn Perinatal Network
Children’s Defense Fund – New York
Coalition for Asian American Children & Families
Commission on the Public’s Health System
Empire Justice Center
Federation of County Networks, Inc.
Flatbush Caton Vendors
Fort Greene SNAP
Jamaica Neighborhood Center
Long Island Health Access Monitoring Project
Medicaid Matters New York
Mental Health Empowerment Project
New York Immigration Coalition
New York Lawyers for the Public Interest
New York State Nurses Association
New Yorkers for Accessible Health Coverage
People’s Budget Coalition on Public Health
Resource Center for Accessible Living
Southern Tier Independence Center
Staten Island Center for Independent Living
United Bronx Parents