Cut to DHS budget to cost medical center

A cut to the Iowa Department of Human Services budget will cost Greene County Medical Center an estimated $50,000, at a minimum.

Tracy Warner, UnityPoint Health director of rural health resources, told the medical center trustees at their April 27 meeting that the DHS budget approved by the legislature cut Medicaid funding for “cross-over claims”. Under the current budget, a patient who is on both Medicare and Medicaid has his Medicare deductibles and copays paid by Medicaid. That will end with the new budget.

Warner mentioned as a caution that the medical center’s bad debt will possibly increase.

Also, the new budget eliminates retroactive eligibility for Medicaid. Now, a person who needs medical care but is not signed up for Medicaid can be presumed eligible. The person gets care and someone at the medical center assists in filling out the Medicaid application. The person’s eligibility is back dated prior to the event for which the person was treated, Warner explained.

“Those are two efforts that have been under way for years but have never been successfully implemented,” Warner said.

“So basically, we’ll be writing off [the care for] people that aren’t signed up for Medicaid. We have to know that we’ll be writing off their first initial visit until we get them signed up, or we need to start banging on doors and asking people if they want to fill out Medicaid applications so they’re ready to go,” medical center CEO Carl Behne said.

Chief medical officer Jon Van der Veer said that challenge is that often times, “when people first show up is when they’re the sickest. Their most expensive visits are the ones that won’t be paid.”

“The legislature was tough on healthcare this year,” medical center trustee Kim Bates said.

In follow up, Behne said there’s no way to predict how many people would go to the medical center who are eligible but not enrolled in Medicaid.

Last year there were approximately 4,000 visits to the emergency room.

The average cost of an ER visit for non-emergency care (a cold or stomach ache, for example) was $1,047. The average cost of all ER visits (non-emergency and emergency) was $1,600. Looking at the percentage of visits by Medicaid recipients and the percentage of people who are eligible but not registered, there could be 27 to 30 patients for whom the medical center would not receive payment. The cost would go into the medical center’s bad debt.

In his report, chief financial officer Mark Vander Linden projected $544,000 in bad debt for the year ending June 30. “It’s certainly higher than 2016…. I still believe it’s MCOs and the Medicaid expansion we’ve had in the last couple years,” he said.


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