During a meeting at the Heritage Foundation last week, Gov. Pat McCrory said a new regulation might lead to the expansion of Medicaid, despite the state turning it down last session.
In July, the Centers for Medicare and Medicaid Services announced they would require state Medicaid agencies to allow hospitals autonomy to determine whether they would accept additional categories of patients.
Among the people who could be accepted are parents, caretakers, patients with breast or cervical cancer, senior citizens, former foster care children and those wanting family planning services.
Don Dalton, the vice president of public relations for the N.C. Hospital Association, said Medicaid was originally focused on providing care for women and infants.
“Before the Affordable Care Act, there was one category of Medicaid patients that hospitals could presume were eligible for Medicaid,” said Dalton.
Katherine Restrepo, a health policy analyst at the conservative John Locke Foundation, said in an email that presumptive eligibility for Medicaid in North Carolina is based on the federal definition of the poverty threshold.
“North Carolina currently offers presumptive eligibility to pregnant women who earn an annual household income of 185 percent of the Federal Poverty Level or less.”
Ryan Tronovitch, deputy communications director for McCrory, said in an email that increased eligibility could cost the state.
“The troubling aspect of the rule is that if a hospital incorrectly signs up a person for Medicaid benefits who is not eligible, the state cannot recoup those funds spent during the presumed eligibility time period,” he said. “This cost could be a significant budget variable.”
But Dalton said hospitals are not required to change their policies.
“Hospitals have a choice of whether to implement the presumption of eligibility in these new categories.”
The federal government is able to require states to provide hospitals and other healthcare providers with the option of accepting the new classes of patients, if the hospitals choose to, because Medicaid is maintained by federal as well as state funds.
“For roughly every dollar the state spends on Medicaid, the federal government matches it with two dollars,” Dalton said.
Dalton said Medicaid only compensates healthcare providers 73 percent of the cost required to perform services, which combined with other classes of patients, like those who are uninsured or enrolled in Medicare, means prices are higher for those patients who have insurance.
Restrepo said one of the key changes to Medicaid policy would be hospitals’ ability to create a State Plan Amendment, which would allow adults without children to become available for Medicaid coverage.
“Should the State Plan Amendment follow through, this will be considered an expansion, as childless adults are not currently covered under North Carolina’s Medicaid program.”
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