Thursday, April 10, 2014

Without Medicaid expansion in their states, some rural hospitals are struggling to remain open

Some rural hospitals in states that chose not to expand Medicaid under federal health reform are struggling to keep their heads above water, and continue to fall deeper into financial danger. One such state is Mississippi, which would have gained an addition $2.1 billion a year through federal Medicaid payments, netting the state $431 million, Jerry Mitchell reports for The Clarion-Ledger in the state capital of Jackson. But without expansion, Dr. Luke Lampton, chairman of the state Board of Health, told Mitchell, “A lot of the rural hospitals aren’t going to survive. Most have low censuses, with poor, elderly and vulnerable patients and are barely making money.”

Without expansion, "Lampton said, hospitals are still having to pay the additional costs of the new regulations, which some have estimated as high as billions nationally," Mitchell writes. "He said many rural hospitals in Mississippi are hurting, with some slashing operational costs and laying off employees. Southwest Mississippi Regional Medical Center of McComb recently announced hundreds of layoffs."

"Rural hospitals have also been hurt by cuts in reimbursements, totaling $170 billion in recent years, according to the American Hospital Association," Mitchell writes. "Nationally, hospitals have an $8 billion shortfall from Medicaid reimbursements, a $24 billion shortfall from Medicare reimbursements and a $41 billion shortfall from uncompensated care, according to the association."

As a result, "Mendal Kemp, program director for the Mississippi Hospital Association’s Center for Rural Health, said some rural hospitals are aligning with bigger hospitals to survive," Mitchell writes.  "Thirty-two rural hospitals in Mississippi have signed up as critical-access hospitals, which promises them cost-plus-1-percent payments from the federal government. But Kemp said cuts to that funding could come if another government sequestration takes place." (Read more)

Maine, which has the largest percentage of rural population in the U.S., is the latest state choosing not to expand Medicaid. On Wednesday, Republican Gov. Paul LePage "vetoed a bill that would have expanded MaineCare coverage to more than 60,000 low-income Mainers," Steve Mistler reports for the Portland Press Herald. "The measure also would have established a managed care system for all 320,000 beneficiaries, an effort to control costs in the $2.5 billion program, which is Maine’s version of the Medicaid health insurance program." It was the third time LePage has rejected expansion. (Read more) (Advisory Board Co. map: Many states with large rural populations and Republican governments chose not to expand Medicaid)

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