safety-net hospitals


What’s Going On With The State’s Medicaid Waiver?

Dr. JudyAnn Bigby has requested a Medicaid waiver extension -- again.

Once again, the state has asked for another extension for a Medicaid waiver related to the 2006 health law.

Here’s the Nov. 29 letter from JudyAnn Bigby, Massachusetts Secretary of the Executive Office of Health and Human Services requesting the extension from the Centers for Medicare and Medicaid Services until Dec. 31.

A spokesperson for the the state said she couldn’t get into specifics but wrote in an email: “I can say that the Obama Administration understands the importance of the waiver to health care reform in Massachusetts and  we are working collaboratively with them to finalize provisions of an agreement.” 

OK, so why are negotiations stalled? Obviously, it’s money for our safety net hospitals, but where are the details?

Here’s Josh Archambault, director of health care policy at the Pioneer Institute, dutifully covering the issue on his blog. Today he quotes from a Statehouse News report:

HIGH-STAKES MEDICAID TALKS DRAG ON: Secretive negotiations between the Patrick administration and the Obama administration over the distribution of billions of dollars in Medicaid funding have failed to produce an agreement and will continue into December. The outcome of the talks, which are occurring as Washington looks to ratchet back spending and address bulging deficits, will have major ramifications for the state’s health care reform efforts….The Patrick administration is believed to be seeking a three-year agreement with the federal Centers for Medicare and Medicaid Services that includes billions of dollars in funding for hospitals that care for low-income and uninsured residents. U.S. Sens. John Kerry and Scott Brown, along with the entire Massachusetts Congressional delegation, pleaded with CMS chief Donald Berwick last month to preserve $4.6 billion to care for those uninsured or underinsured residents, as well as special payments to the hospitals that care for them….

With Health Reform, An Increased Demand For Safety-Net Hospitals, Study Finds

It’s always good to get an outsider’s perspective.

So, with that in mind, here’s a new study with findings that are no surprise to health policy types in Massachusetts, but may be notable to everyone else, including the researchers from Washington, D.C. and elsewhere who carried out the analysis. Published today in the Archives of Internal Medicine, the study found that even after the Massachusetts health reform law and a spike in the number of people with health insurance, patients still chose to get care at safety-net hospitals and community health centers. Most people surveyed said they continued to seek care at these hospitals and health centers because they were convenient and affordable or provided important, non-medical services.

Why do patients stick with safety-net hospitals?

The study concludes: “Despite the significant reduction in uninsurance levels in Massachusetts that occurred with health care reform, the demand for care at safety-net facilities continues to rise…Most safety-net patients do not view these facilities as providers of last resort; rather, they prefer the types of care that are offered there. It will continue to be important to support safety-net providers, even after health care reform programs are established.”

Study author Leighton Ku, Ph.D., M.P.H., from George Washington University, Washington, D.C., explains that some people thought that once patients got an insurance card, they’d flee the safety-net hospitals. “You might think that the newly insured would choose to go to the MGHs not the Boston Medical Centers, the private doctors in Back Bay, not the community health centers…but that is not what we found.” Continue reading