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CHCs feel crunch of Medicaid documentation

WASHINGTON –The House and Senate are considering legislation to ease Medicaid enrollment documentation requirements put into place in July 2006. The requirements are intended to keep illegal immigrants from receiving coverage under the cash-strapped program, but researchers have found that some eligible U.S. citizens have also had a difficult time meeting the requirements.

Hoping to influence Congress on the issue, RCHN, a national foundation that supports community health centers, and the George Washington University School of Public Health and Health Services are repeating a May 2007 survey of health centers. The original survey found that delayed enrollment for potentially eligible Medicaid beneficiaries is disrupting coverage and affecting compensation at the CHC level.

The health centers, which are federally-funded and intended to provide comprehensive care to medically underserved areas, have reported financial consequences as they serve patients awaiting Medicaid eligibility decisions.

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“Health centers are not getting revenues that they otherwise would be getting under Medicaid,” said Feygele Jacobs, chief operating officer of the RCHN Community Health Foundation.

By their mission, CHCs will continue to see people even if they don’t have coverage, and they will see people without guarantee of payment, Jacobs noted.

“You might see health centers providing care without guaranteed compensation. If you have people who were otherwise eligible and might come in with an insurance card, but their verification is taking longer, the center might see the patient, but today they are not being reimbursed,” Jacobs said.

RCHN and GWU randomly polled 300 of the nation’s roughly 1,000 CHCs, and about half responded. “We found out that at least nine-tenths reported some negative impact on some group of their Medicaid patients,” said Peter Shin, associate research professor and research director at GWU and author of the study.

CHCs receive about 37 percent of their funding from Medicaid revenues, Shin said. He estimated that 40 percent of the centers’ care is uncompensated by any payer.

“In general, the clinics absorb that cost,” he said. “Just like everybody else, they sort of have to work with what they’ve got.”

“Because the finances are impacted, (CHCs) have to change their scope somewhat to see what they can provide,” said Shin. “Their linkages to specialists are disrupted as well.”

The Kaiser Commission on Medicaid and the Uninsured released a Jan. 9 report which found that, in light of the new documentation requirements, 74 percent of eligible uninsured children from low-income families are not currently enrolled in either the State Children’s Health Insurance Program or Medicaid.

Shin said the best solution for all involved is to go back to the pre-legislation way of managing eligibility for the affected populations. “That’s when the states were doing a great job of keeping illegal immigrants off the program,” he said.