If federal health reform kicks in according to schedule, more than 600,000 Kansans could be eligible for Medicaid by 2014.
That’s more than double the number of people currently in the program.
Federal health reform would open Medicaid to any legal resident earning 133 percent or less of the federal poverty level. Currently, that is $14,404 a year for an individual or $29,327 for a family of four.
The Kansas Health Policy Authority, which oversees the state’s Medicaid program, in a preliminary estimate predicted the reform only would add about 100,000 to the rolls because many people otherwise newly eligible would be covered by private insurance, perhaps purchased through new exchanges also created by the reform law.
But whether 100,000 or 300,000 new people come into the program, there are questions about the capacity of health care providers to serve them. The state currently has about 285,000 Medicaid beneficiaries.
Many health providers refuse to see Medicaid patients or limit the number they will accept because the program’s reimbursement rates are low compared to those of private insurers or because they already have as many patients as they can manage.
Currently, low-income people without insurance or who are underinsured often end up at the states’ safety net clinics.
Large influx predicted
The clinics also see people on Medicaid who can’t find other providers. And that number could grow significantly after 2014.
“I know a lot (physicians) don’t take Medicaid,” said Krista Postai, executive director for the Community Health Center of Southeast Kansas, a Pittsburg safety net clinic, “but even those that do – they’re not taking on any more patients because they’re already booked solid for 30, 60 90 days.”
“We end up seeing a lot of single men and women between the ages of 30 and 50, who don’t have enough out-of-pocket money to see a doctor,” Postai said. “They know something’s wrong. They put it off for as long as they can and then they come here. We’ve had people come here, find out they have cancer and die within weeks. That’s how sick they were.”
Many people like that soon will be eligible for Medicaid.
“A lot of these people – there’s no way to know how many – will be turning to the community health centers because most private physicians see Medicaid reimbursement as being pretty low,” said Tony Wellever of the University of Kansas School of Medicine Center for Community Health Improvement.
Money to expand
Eventually, the expanded coverage is expected to cost the state tens of millions of dollars.
“A lot of governors are yelling about this now,” Wellever said. “My guess is that when the time comes many states will cut back on their reimbursement just to be able to afford the expansion, which will cause physicians to see even fewer people on Medicaid. The community health centers, it’s safe to assume, will see even more people on Medicaid.”
To accommodate the anticipated influx, the reform package includes $11 billion to help safety-net clinics expand over the next five years.
“Eleven billion dollars?” Postai said. “After being under-resourced for so long, I can’t get my head around what that means or what it looks like but we’re all talking about it. In the next three to five years, we could be looking at double the number of health centers or double the number of access points.
“Our No. 1 goal is to be ready for the tsunami we all know is coming,” she said.
The $11 billion will be distributed using a competitive-grant process.
Representatives of the Kansas Association for the Medically Underserved, the organization that represents the state’s safety net clinics, have already met with administrators at each of the state’s 13 Federally Qualified Health Centers (FQHC) to discuss the grants.
Meetings with the state-funded primary care clinics also are in the works.
“Reform is going to affect different clinics in different ways,” said KAMU Executive Director Cathy Harding.
Capital improvements
Part of the $11 billion, she said, has been set aside for helping mid-level primary care clinics become FQHCs, a designation that triggers additional federal support.
“Some centers, I suspect, will be applying for FQHC status for the first time,” Harding said. “Others will say, ‘No thanks, that’s not our mission,’ and that’s perfectly acceptable.”
Harding said $11 billion is a lot of money, but it may not be enough.
Last year’s federal stimulus funding, she said, included $1.5 billion for capital improvements at safety-net clinics.
“That’s great, that’s wonderful,” Harding said. “But they got so many grant requests there are still $2.7 billion worth of projects that went unfunded.”
None of the grants were awarded to a clinic in Kansas.
“In Region 7 – the four-state region we’re in with Missouri, Iowa, and Nebraska – there was only one award,” Harding said, “and it went to a project in Council Bluffs (Iowa).”
Kansas safety net clinics did get $3.1 million in stimulus money to hire or retain staff in order to deal with new patient loads.
In Kansas, six safety-net clinics limit their caseloads to patients who are uninsured. Medicaid patients are considered insured and are referred to other clinics.
Slipping through the cracks
Though reform is expected to result in most people being insured, no one, Harding said, expects the six so-called free clinics to become obsolete.
“If there’s one thing we’ve learned over the years,” she said, “it’s that no matter how well a system is designed, people are still going to fall through the cracks. The projections I’ve seen show about 5 percent of the population will be uninsured for one reason or another.”
Nikki King runs Health Care Access, a free clinic in Lawrence.
“For us, that 5 percent in Douglas County is 7,000 people,” King said. “We’re doing everything we can, and we’re seeing between 1,500 and 2,000 patients a year, so there’s a lot of additional capacity building to be done between now and 2014.”