TCMH is supporting a plan to expand Medicaid coverage in the state to offset losses expected with national healthcare reimbursement.

Texas County Memorial Hospital has endorsed a state plan that would expand Medicaid coverage to underserved residents in the county.

The Patient Protection and Affordable Care Act provides all states the opportunity to expand state Medicaid coverage. This Medicaid expansion would provide coverage to previously uninsured individuals. Currently, Missouri legislators are considering whether to participate in the Medicaid expansion program.

“We support this expansion in light of what it would mean for providing care for the citizens of Texas County and what it means for our hospital revenues,” said Omanez Fockler, chairperson of the TCMH board of trustees.

According to the Missouri Hospital Association (MHA), in 2014, more than 24,000 jobs could be created if Missouri participates in the Medicaid expansion plan included in the Affordable Care Act. Research from the University of Missouri found that expansion could add $9.6 billion to the state’s economy in value-added output in 2014 — increasing gross state product by more than one-half percent.

The University of Missouri research also found that not expanding Medicaid could cost Missouri more than 9,000 jobs, $1.9 billion in reduced capital investment or $1.1 billion in cost shift to the insured. This forecast is based on cuts included in the Affordable Care Act and Budget Control Act of 2011, which when combined, reduces hospital reimbursement by $4 billion between 2013 and 2019.

According to the university’s research, if Medicaid is expanded, as many as 220,000 enrollees would be eligible for the program, significantly reducing the number of the uninsured in the state. Between 2014 and 2020, the federal portion of this state-federal program would cover 96.1 percent of the cost.

“Medicaid expansion has a huge impact on TCMH,” Murray said. “The vast majority of those receiving Medicaid coverage through expansion are those who work but do not have access to or cannot afford health insurance.”

Murray explained that in the past TCMH has received additional federal dollars due to the number of Medicaid patients seen at the hospital through a “disproportionate share” program. Those additional funds are going away under the Affordable Care Act.

“This expansion will help soften the blow of losing the disproportionate share,” Murray said.

Dr. John Duff, CoxHealth representative, agreed with Murray’s assessment.

“Rural hospitals, which see more Medicaid patients than hospitals in bigger communities, are hit doubly hard by losing the disproportionate share,” Duff said.

Murray described the Medicaid expansion as “affecting our business interests.”

“We have a growing number of working people that are not able to pay their hospital bills,” Murray said.

In 2011, TCMH provided $5.6 million in uncompensated care to patients in the county.

“We as a hospital are here to provide health to the citizens of Texas County, and we have to consider how our revenue is affected by Medicaid,” Fockler said. “We have to encourage the state legislature to approve this expansion regardless of our political persuasion.”

Murray has spoken with state legislators regarding Medicaid expansion and its effects on TCMH.

“We service the healthcare needs of a growing number of people that work but do not have or cannot afford health insurance,” Murray said. “We need to be sure our legislators understand how Missouri Medicaid expansion affects the business interests at TCMH.”

Duff told board members that the CoxHealth board has passed a resolution supporting Missouri Medicaid expansion. In addition to CoxHealth, TCMH joins Ozarks Medical Center in West Plains, Salem Memorial District Hospital and other hospitals around the state in supporting the expansion.

Murray reported that the TCMH Medivan, the non-emergency transportation service operated by TCMH, has a contract in hand to contract with Medicaid to provide transportation for Medicaid patients.

“There are many occasions that we provide transportation without any reimbursement,” Murray said, recounting the story of a hospital patient that was discharged at 4 p.m. on a Saturday and at 11 a.m. on Sunday, the patient was still waiting for the Medicaid transportation service to provide a ride home.

“The Medivan will not provide services all over the state like some Medicaid transportation services,” Murray said. “We will be able to provide the service to TCMH patients and receive some reimbursement for the service.”

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