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Minor Medicaid Miracle

Minor Medicaid Miracle

ADHC staff and clients (pictured at Housing Works 13th Street) are safe from cuts for now

Despite fears over a new Medicaid regulation that would decimate outpatient clinics, fixes to the final regulation mean that clinics are safe for now. Last week, thanks to heavy lobbying by advocates and New York State officials, President Bush passed a Centers for Medicaid and Medicare Services regulation that vastly improved on an original proposal.

“We definitely dodged a bullet,” said Harlem United Executive Director Patrick McGovern. Harlem United’s two Adult Day Healthcare Clinics (ADHC) would probably have been forced to close if the regulation had passed in its original form.

The regulation nixes language that would have capped federal matching funds for Medicaid reimbursement for hospital and community-based outpatient services at the substantially lower Medicare rate and wouldn’t have allowed federal matching funds for some Medicaid outpatient services that Medicare doesn’t recognize. Eighteen states would have been affected, and New York State would have lost $450 million for outpatient clinics.

Bad news for hospitals

The regulation isn’t perfect, however. Part of the regulation limits the amount of money Medicaid can reimburse hospitals for performing outpatient services, undermining New York State’s efforts to increase outpatient care.

“The regulation is a good news-bad news story,” said New York State Medicaid Director Deborah Bachrach. “The requirement that states use the Medicare fee-schedule was moved and that’s a very important victory. Unfortunately, at the same time, the regulation clarifies a rule that applies to how we deliver care at hospital clinics.”

The state is still hoping that Congress will pass a moratorium on this regulation during the possible lame-duck session. Obama has stated his opposition to the provision and could possibly draft a new regulation come 2009. However an Obama save is not promised, and waiting on this possibility would create havoc in the short-term. For more about how hospitals throughout the country will be affected, read the New York Times report.

No time to breathe easy

Despite the good news, these are just bad times to be a poor person needing medical care. Gov. David Paterson said Medicaid spending will face cuts, and has proposed Medicaid spending cuts, even though the numbers of people on the Medicaid roles are increasing as the state plunges into recession. It is still unclear if Congress will pass a second economic stimulus package that would include state aid for Medicaid.

And ADHCs are in a particularly precarious position. ADHCs provide a “one-stop-shop” array of programs for people living with AIDS, including medication management, health care monitoring, case management, mental health and substance abuse services, nutritional services, and health education. The programs are unique to New York.

The state provided the programs a long-overdue $1.4 million increase this year, but there has been no federal match. An ADHC almost closed its doors in Long Island last year, because it couldn’t pay the bills and was only saved by last minute private donations, and there is worry others might also suffer.

“We need to be vigilant. Because the ADHCs are such niche healthcare programs, it’s critical we don’t lose sight tracking changes in state healthcare reform initiatives and the new Congress,” said Harlem United Deputy Director for Policy & Government Relations Soraya Elcock.

Posted on November 13, 2008 at 10:54 pm