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Centers say their experiences are reflected in study
Although no Colorado-specific data are part of the George Washington University survey on the impact of documentation requirements on health centers, Colorado Community Health Network policy director Polly Anderson tells State Health Watch that anecdotal information from the 15 plans in the network indicates the study accurately reflects the situation the Colorado plans are experiencing.
"We're seeing problems in two areas—Medicaid-eligible citizens and the centers that care for them," she says. According to Ms. Anderson, it is common for health center patients not to have a driver's license or other photo identification. She says that's often most true for the most vulnerable populations. "They are eligible and entitled to benefits," she says, "but are unable to prove they are citizens or lawful residents." Ms. Anderson says the centers continue to provide care to patients who lose their Medicaid coverage, seeing them as uninsured patients, but find they have more difficulty obtaining specialty care and hospitalization for them.
Centers are affected, she tells us, because of both the potential revenue loss and the administrative time needed to help patients navigate the system and obtain the documents they need.
More than 90% of Colorado centers report enrollment problems, she says, and more than 33% have increased staff time used to help patients complete their applications. Some plans are forced to spend up to $32,000 per year for a full-time equivalent position to help applicants, she says. "That money could be better spent on direct care," she asserts. Providers just outside the Denver metro area have said they are finding it takes two visits to screen and enroll applicants instead of the previous one visit.
Ms. Anderson says the National Association of State Medicaid Directors has said the new requirement is not having the intended effect and is instead a barrier to states meeting their Medicaid objectives. "Our state agency says they may save $300,000 as a result of implementing the requirement," she says. "But that savings comes at a cost of $2.9 million to implement the provision. And I'm not aware of anyone providing nonemergency services to illegals."
The best solution, according to Ms. Anderson, would be for Congress to eliminate this requirement. She says it's possible that the SCHIP reauthorization bill would be used to make the Deficit Reduction Act requirement optional for states.
The George Washington University health center survey report says Valley Wide Health Systems that serves some 50,000 patients in southern Colorado, reported a substantial backlog of applications awaiting documentation. As a result, the plan said, patients are experiencing periods without coverage lasting weeks longer than the normal application process would otherwise have required. Because the patients have significant health needs that must be met regardless of their insurance status, the health center has absorbed the costs.
"We see a lot of Medicaid patients as we are the main game in town," says Valley Wide Health Systems executive director Marguerite Salazar. "The cost has gone up because we've had to hold on to applications longer. Our cash flow is affected because we're not billing."
Ms. Salazar says the requirements have increased the health center's administrative obligations at the same time that their cash flow has been affected. "The bottom line is that these requirements have caused an increase in administrative costs," she says. "Every time you are helping patients with paperwork, you are taking time away from patient care. And that's unfortunate."
New York State has required documentation of citizenship for Medicaid for the past 30 years. Many observers assumed that the documentation requirements would have little impact. But staff at Community Health Care Network in New York City, which serves more than 60,000 patients, say that's not the case.
The plan reports significant declines in recertification rates among patients who are citizens, nationals, and qualified aliens. Adolescents seeking family planning services have been particularly affected, plan officials say. Before the new federal regulation, the state had permitted minors to submit copies of necessary documents. But this policy is no longer permissible because the federal rule requires either originals or certified copies.
Barriers to family planning services
Teens continue to have access to family planning services, the officials say, but on an uninsured basis since the change in law has prevented teens from keeping or acquiring Medicaid coverage.
Community Health Care Network of New York president Catherine Abate says the policy is contributing to an even greater growth of uninsured patients who depend on the clinic and says the situation is "woeful." Although the report came out when it was still early in the annual recertification process, clinic staff reported a 50% enrollment drop over several months in one of the managed care plans in which the health center participates.
Case studies can be found in the research report available on-line at www.mpca.net/files/Medicaid%20call/Medicaid_Doc_Requirements_Dept_of_Health.pdf. Contact Ms. Anderson at (303) 861-5265, ext. 246.