Cook County Health seeks early expansion of Medicaid

Crain’s reports:

“The Cook County Health and Hospitals System is seeking approval to add thousands of uninsured patients to the Medicaid rolls nearly two years early, a move that could generate millions of dollars in new revenue for the cash-strapped network.

Approval would mean that the public health system would be reimbursed for some of the roughly $550 million of annual free care it now provides. Cook County health system executives decline to say how much revenue they expect to gain. The system treats about 100,000 uninsured patients a year, though that includes people who are ineligible for Medicaid.

The additional revenue could reduce the annual subsidy — $252 million for 2012 — that county taxpayers pay to keep the health system afloat.

Pushing the application through is at the top of the health system’s “life or death” list for financial survival, said Warren Batts, chairman of the independent hospital board that oversees the health system.

The federal health care overhaul calls for a massive enlargement of the Medicaid program in 2014. The expansion is expected to create competition among health care facilities for Medicaid patients, potentially threatening the Cook County health system’s already weakened finances.

The county health system wants the new Medicaid eligibility rules to be applied to its patients later this year instead of waiting until 2014, when federal health care reform begins. Such a move would give the public hospital system a competitive head start on serving the new Medicaid patients.

“When 2014 comes, almost all the people that we would treat would have Medicaid available to them, and unless we perform with a very good patient focus, we’ll end up with a fairly sizable operation with even greater need for a subsidy because we won’t have offsetting revenues coming from regular Medicaid patients,” Mr. Batts said.

The Obama administration already has approved an early start to the new Medicaid rules in four states, according to Menlo Park, Calif.-based Kaiser Family Foundation, which specializes in health care policy.

Cook County’s application likely will prompt badly needed changes, said Margie Schaps, executive director of the Health and Medicine Policy Research Group, a Chicago-based advocacy organization.

“I think this will force (the county) to put better systems in place, to organize health care in a way that best serves the patients, and it will help ensure that the county system has a base of revenue so that it can operate and continue to serve the people in need who don’t have insurance,” she said.

As soon as this week, county health executives expect to start the approval process by submitting a proposal, via the Illinois Department of Healthcare and Family Services, to the Centers for Medicare and Medicaid Services. The U.S. Department of Health and Human Services has final approval.

The county health system will propose creating a coordinated care network that would connect patients with primary care physicians. The goal is to slash overall Medicaid spending by increasing preventive care and limiting expensive hospital stays, said Dr. Ramanathan Raju, the system’s CEO.

“By making sure the patients go to their doctors in a timely fashion, making sure they take their medication on time, a lot of high-end emergency care can be avoided,” Dr. Raju said.

Approval could be granted as soon as July, he said.

Uninsured patients account for about 20% of the roughly 500,000 people the public health system treats each year. Some of those uninsured patients are undocumented immigrants who will remain ineligible for Medicaid even under the new rules, except in emergencies.

Another 150,000 county patients are expected to qualify for expanded Medicaid coverage in 2014, Dr. Raju said.”