Medicaid calls state to task

Last modified: 6/5/2012 12:00:00 AM
Federal Medicaid officials are threatening action against the state if it cannot show within 30 days that Medicaid patients still have access to health care given that lawmakers drastically reduced Medicaid payments to the state's hospitals last year.

The $230 million cut in state and federal money forced several hospitals to lay off staff and some to say they could no longer afford to treat Medicaid patients. Ten of the state's 13 largest hospitals are suing the state in federal court over the cuts.

The judge overseeing that case concluded in a ruling issued in March that the state was 'highly likely' to have violated federal Medicaid rules in the way it cut reimbursement rates to hospitals. The case is still pending.

The May 23 letter from the Centers for Medicare and Medicaid Services to Health and Human Services Commissioner Nick Toumpas echoes concerns raised in the lawsuit. It follows months of seemingly unsuccessful negotiations between the two.

'While this is a short time frame, (the center) and the state have been talking about these issues for four months, and we requested the data when we met in March,' wrote Cindy Mann, director and deputy administrator of the Centers for Medicare and Medicaid Services.

Mann's letter did not specify what penalties the state could face, and a center spokesman declined to say whether federal officials were considering withholding the $600 million in federal Medicaid money New Hampshire receives each year.

In response to media calls yesterday, Toumpas made public his response to Mann. Contrary to claims from hospital officials, Toumpas said, his office has no proof that Medicaid patients cannot find doctors and hospitals to treat them.

Toumpas accused Mann of misrepresenting the level of cooperation his office has given to federal officials since they began meeting in January. He said the state has provided much of the information federal officials have requested. In fact, Toumpas added, federal officials have been unwilling to review some of it.

He used the Lakes Region General Hospital as an example.

This fall, that hospital notified 3,500 patients that the Medicaid reimbursement cuts meant it could no longer afford to treat Medicaid patients at some of its primary care practices. In his letter, Toumpas said only 1,000 of those patients were on Medicaid, and of those 1,000 patients, 600 had received care elsewhere.

Toumpas said that left 400 Medicaid patients 'potentially' in need of a new primary care provider. Their needs could be met, Toumpas said, by four other primary and family care clinics 'in close proximity' to the hospital.

He told Mann he had provided her similar information about other hospitals that had alleged their Medicaid patients would go without care.

'This information,' Toumpas wrote, 'clearly demonstrates that there has not been, currently is not, nor will be any evidence of a barrier to access to Medicaid recipients in New Hampshire.'

At issue is a tax that has long been imposed on the hospitals to raise money in order to secure matching federal funds.

That tax generates about $115 million from the state's hospitals each year. The state turns that into $230 million by using the federal Medicaid dollar-for-dollar match. In year's past, the state returned some of the matching money to the hospitals to compensate them for unpaid Medicaid treatment.

Last year, the Republican-controlled Legislature eliminated the payment to hospitals and instead used the money to balance the state budget. Dartmouth-Hitchcock Medical Center, one of the 10 hospitals suing the state, is losing about $100 million a year, said Frank McDougall, vice president of government affairs at Dartmouth-Hitchcock. Concord Hospital, which did not join the federal lawsuit, is losing between $13 million and $18 million.

'I think this (letter from the center) is very significant,' McDougall said. 'When you hear from a federal judge that the (Medicaid) program is below standard and broken and then you hear it from a . . . federal agency, I think they validate each other. And they validate what we have been saying.'

Henry Lipman, a vice president with Lakes Region General Hospital, agreed. 'I think they've said to the state, 'You haven't been able to satisfy us either. If you can't, you run the risk of compliance action.' '

Michael Green, president and chief executive officer of Concord Hospital, was reluctant yesterday to interpret the seriousness of the letter from federal officials.

'I see this as somewhat of a delicate dance between the state Department of Health and Human Services and Medicaid (officials),' he said. Green questioned the likelihood that federal officials would withhold Medicaid money if their goal is to, instead, ensure Medicaid patients have access to care.

'I hope and I do anticipate that the state and federal government will resolve this before the federal government seriously considers withholding payment,' Green said. 'I don't see how that is constructive.'

(Annmarie Timmins can be reached at 369-3323 or atimmins@cmonitor.com or on Twitter @annmarietimmins.)




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