Our New Admission Via The Medicaid Expansion Program

We just accepted an admission today of a 61 year old patient who has a newly minted Medicaid number via the new Obama driven Medicaid Expansion Program.

This was a first for me and I had to dig really deep to uncover the nuances of this albatross as far as its effect on my area of purview (and special thanks is due to one my mentors, Marlene Grossman of the Regency Jewish Heritage in Somerset, who is a fountain of knowledge in every facet of Healthcare coverage and eligibility) and was intrigued by some of the differences between this new Medicaid vs. traditional models and Medicaid HMO’s, which have become the norm for Medicaid recipients living in the community.

For one thing, this patient is not currently enrolled in a “Managed Medicaid,” concurrent with her January 1, 2014 Medicaid eligibility. Instead, she will actually be enrolled into her Amerigroup HMO Medicaid in April after she will have already been here for some time. This is exactly in reverse of the traditional model, whereby said patient is discharged to us from the hospital via an authorization for SAR or SNF levels of care from their managed Medicaid (HMO), prior to us transferring over to traditional Medicaid.

The ramifications of this, is significant on a few levels. Most importantly, is the effect it has on our ability/inability to provide the requisite therapy for someone depending upon their needs and level of acuity.

For example, a patient who is discharged to us that is enrolled in a Medicaid HMO, we have the ability to secure a subacute authorization from their provider in order to provide robust therapy.

However, under these new conditions, we are left to provide a restorative level of therapy before possibly utilizing an authorization for a higher level of care at some point later on.

It is difficult for me to see how this plan benefits the resident, but this isn’t a political article and I don’t wish to digress.

Now to provide some perspective on this new law, I present you with some factoids:

When the health care law was passed, it required states to provide Medicaid coverage for adults between ages 18 and 65 with incomes up to 133% of the federal poverty level, regardless of their age, family status, or health.

It also provides tax credits for people with incomes between 100% and 400% of the federal poverty level to buy private insurance plans in the Marketplace.
Under the law, the federal government will pay states all of the costs for newly eligible people for the first three years. It will pay no less than 90% of the costs in the future.

The U.S. Supreme Court later ruled that the Medicaid expansion is voluntary with states. As a result, some states are not expanding their Medicaid programs.
Many adults in those states with incomes below 100% of the federal poverty level fall into a gap. Their incomes are too high to get Medicaid under their state’s current rules. But their incomes are too low to qualify for help buying private coverage in the Marketplace.

The Affordable Care Act was designed to protect these people.

I guess time will tell…

Leave a Reply