Aca and Medicaid update

It is expected that an ACA repeal-replace bill will be considered the week of March 6 in the House Energy and Commerce Committee. The draft of the bill hasn’t been published or circulated at this time but we understand that it addresses both the ACA and Medicaid.  

Specific to our key issues, there are three areas of importance to California’s district/municipal hospitals included in the rumored bill: 

– Move Medicaid to a per capita cap system with a base year of 2015 and include some sort of annual inflation. A per capita cap means that the state would get a set amount of funding per Medicaid beneficiary. It would be annually adjusted for inflation although details of what that rate would be is unclear. It is also unclear at this time what payments would be included in the calculation of the base year (all Medicaid payments vs limiting certain supplementals from inclusion)  and if the base year is a calendar year or federal fiscal year. 

– Eliminate the Medicaid expansion population; a phased in elimination likely to be complete by 2020 in terms of the enhanced FMAP states gets for this population. Additionally, there is discussion about including language that would limit the enhanced FMAP to the current expansion population so if states continue to add to the expansion population between now and 2020, then they would not receive the enhanced FMAP for the “newly” insured. Also, for expansion beneficiaries that fall out of Medicaid for whatever reason and then re-enroll, the enhanced FMAP would also not be available to them upon re-enrollment. 

– As you know, hospitals provided some of the funding for the ACA.  In the current unreleased draft House reconciliation bill to repeal the ACA and impose Medicaid per-capita caps, it would allow Medicaid disproportionate share hospital (DSH) cuts to start Oct. 1, 2017 in states that expanded Medicaid under the ACA. Medicaid DSH cuts would NOT occur in states that did not expand Medicaid, therefore, increasing the DSH cuts to states such as California.  This, obviously, would impact CA and district/municipal hospitals significantly.   

Given this new information and the proposed schedule for mark-up, Forum staff will be in touch with key hospitals that have members who are decision makers due to committee appointments to ask you to make phone calls to speak to staff and the Members about the three issues outlined above. You will hear directly from Forum staff if your Member is on the target list.  

As more information becomes available, we will keep you all informed. Let us know if you have any questions in the meantime.