319,000 Community Health Center Patients Expected To Lose Medicaid Coverage

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Medicaid Coverage

As many as 319,000 community health center patients, including more than 212,000 children, expected to lose medicaid coverage as a result of medicaid documentation requirements.

Medicaid documentation requirements enacted by Congress in 2006 are already having a major and measurable impact on health centers and their patients, according to a new analysis issued by The George Washington University School of Public Health and Health Services (GW/SPHHS). These new requirements -- affecting both children and adults nationally -- are disrupting coverage for thousands of Medicaid-enrolled health center patients, while delaying applications and enrollment for thousands more. Health centers' ability to provide care for both their insured and uninsured patients is being affected.

In 2005, health centers -- the largest source of comprehensive primary care for low income patients -- served more than 14 million patients, including more than 5 million Medicaid beneficiaries and 5.2 million low-income children. Medicaid accounts for 37 percent of all health center operating revenues. Results from this initial national impact assessment, the first study to systematically study the effects of documentation, show that:

* Documentation requirements have caused a nationwide disruption in Medicaid coverage for health center patients, with more than 90 percent of all health centers reporting enrollment difficulties for patients of all ages, including newborn children.

* More than 43 percent of health centers report that patients are experiencing one or more of the following problems: a longer enrollment process, a longer application process, the lack of appropriate documentation or having to pay to get necessary documents.

* One third of health centers report having to increase staff time for patient enrollment assistance.

* Enrollment delays and disruptions have affected the ability of almost half (45 percent) of reporting health centers to arrange for specialty care; 38 percent report difficulties in securing healthcare access for new patients; 28 percent report difficulties in pre-arranging hospital inpatient deliveries for pregnant women, and 24 percent report difficulties in securing supplies and equipment.

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The immediate estimated impact of the new documentation requirements is the loss of Medicaid coverage for some period of time for between 2.2 percent and 6.7 percent of all Medicaid enrolled patients. This estimate is extremely conservative and does not take into account the impact of the changes on newborn children or new applicants. Between 105,100 and 319,500 Medicaid patients, including up to 212,400 children and 107,100 adults, are expected to be affected.

This patient impact estimate translates into immediate Medicaid revenue losses of as much as $85 million. These revenue losses represent:

* Services to as many as 166,000 uninsured patients.

* Staffing reductions of as many as 83 physicians, 66 dental professionals, 18 pharmacists, 33 mental health professionals, or 140 nurses and physician assistants.

* The loss of up to one percent of all health center operating revenues.

* The loss of the entire operating surplus reported by health centers in 2005, which is crucial in planning for unanticipated emergencies.

* As many as 131 "new start" health centers in the nation's poorest counties.

"These initial results underscore that increasing Medicaid enrollment barriers have enormous implications for healthcare access and quality," said Sara Rosenbaum, JD, Hirsh Professor and chair, SPHHS Health Policy Department and a study co-author.

Julio Bellber, president of the RCHN Community Health Foundation, which supports the study as well as ongoing health center research and scholarship at GW, said, "The Foundation is committed to supporting research and dissemination of findings related to access, health equity and the role of health centers. This study presents a clear picture of the devastating impact the Medicaid documentation requirements have -- and will continue to have -- on health centers and their patients." Dan Hawkins, vice president for Federal, State, and Public Affairs at the National Association of Community Health Centers, said, "The report signals the danger for millions who desperately need -- and qualify for -- Medicaid coverage, and the imminent harm facing an already beleaguered healthcare safety net."

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