• State Medicaid to quit paying for ER visits deemed unnecessary, By Carol M. Ostrom, February 7, 2012, Seattle Times: “Intent on cutting state budget health-care costs, Medicaid officials say the program will no longer pay for any medically unnecessary emergency-room visits, even when patients or parents have reason to believe they’re having an emergency. The rules - arguably more drastic than an earlier proposal to limit Medicaid patients to three visits per year for nonemergency conditions - would block payment for ER visits for about 500 different conditions. They would apply to all adults and children on Medicaid, with no exceptions, such as someone being brought in by ambulance or from a nursing home, or when patients have neurological symptoms or unstable vital signs. The new rules are to begin April 1, but a statewide group of emergency doctors, backed by the Washington State Medical Association and the Washington State Hospital Association, are pressing lawmakers to stop the plan, arguing it would shift costs to hospitals and ER doctors and deny care to people with real emergencies…”
• Medicaid may stop covering visits to ER later deemed ‘unnecessary’, By Jordan Schrader, February 8, 2012, Tacoma News Tribune: “Medicaid soon might stop covering emergency-room treatment that state officials decide afterward was ‘not medically necessary.’ A state Health Care Authority rule putting a three-visit limit on unnecessary ER use by poor patients was blocked in court on procedural grounds. The agency has replaced it with a new policy planned to take effect April 1 that would reduce the number of conditions deemed non-emergencies but would forbid even a single unnecessary visit. The doctors and hospitals who sued over the old rule blasted the new plan Tuesday, saying it would leave it up to a ‘faceless bureaucrat’ to decide what’s an emergency. They weren’t ready to say they’ll go to court again over it…”

Without dental coverage, patients seek pain relief in ER, By Alison Bath, January 28, 2012, Shreveport Times: “Louisiana spent $1.7 million on Medicaid patients who visited statewide emergency rooms seeking pain relief from toothaches during fiscal year 2010-11. The year before, the state paid $1.66 million for the same reason, according to Department of Health and Hospitals data. Those hospital visits didn’t solve the problem. Unlike dentists and oral surgeons, ER doctors and other physicians can’t pull a tooth. So, the thousands of Medicaid and other government health program recipients who visit an ER each year in Louisiana seeking help for toothaches, tooth abscesses and other dental emergencies receive only palliative care and a referral to an oral surgeon…”

• State scales back Medicaid shortfall by $300 million, By Jason Stein, January 3, 2012, Milwaukee Journal Sentinel: “In a bit of good news for the state’s strained budget, Gov. Scott Walker’s administration is scaling back by more than $300 million the two-year shortfall projected for state health programs for the poor. But a state health department spokeswoman said that to ensure the state health programs remain affordable, the Walker administration will still seek to proceed with a half-billion dollars in proposed cuts affecting tens of thousands of recipients. In a letter to lawmakers Tuesday, the head of the Department of Health Services said that the shortfall through June 2013 is now expected to be $232 million in state and federal money, down from the $554 million that was projected in September. The change in the projections amounts to about 2% of the funding in the program, Health Services Secretary Dennis Smith wrote in a letter to members of the Joint Finance Committee…”
• Medicaid payment backlog cripples supportive living centers, By Dean Olsen, January 3, 2012, State Journal-Register: “Medicaid payment delays of up to six months are causing fits for supportive living centers throughout Illinois, and some owners are worried they may have to close if the situation doesn’t improve soon. ‘It’s a crisis for us because reserves and lines of credit are being exhausted,’ Wayne Smallwood, executive director of the Springfield-based Affordable Assisted Living Coalition, said last week. ‘This is the worst we’ve seen, and there’s no relief in sight.’ Illinois’ festering budget problems, the sagging economy and the end of the federal economic stimulus program in June have contributed to growing payment delays that also hamstring nursing homes, hospitals, doctors and other medical providers…”
• Nowhere to go, patients linger in hospitals, at a high cost, By Sam Roberts, January 2, 2012, New York Times: “Hundreds of patients have been languishing for months or even years in New York City hospitals, despite being well enough to be sent home or to nursing centers for less-expensive care, because they are illegal immigrants or lack sufficient insurance or appropriate housing. As a result, hospitals are absorbing the bill for millions of dollars in unreimbursed expenses annually while the patients, trapped in bureaucratic limbo, are sometimes deprived of services that could be provided elsewhere at a small fraction of the cost…”

• Low Medicare, Medicaid rates shift costs to insurers, study finds, By Guy Boulton, December 17, 2011, Milwaukee Journal Sentinel: “An estimated $851 million is added to the cost of commercial health insurance to make up for the lower fees that Medicare and Medicaid pay hospitals in southeastern Wisconsin, according to a study released last week. The study, commissioned by the Greater Milwaukee Business Foundation on Health, supports the long-standing position of the hospital industry that the government health programs don’t cover their share of costs and that the shortfall is passed on to employers and individuals through higher prices for commercial health plans. Yet that contention - widely held in the business community and among elected officials - is challenged by most health economists…”
• Medicare penalties for readmissions are likely to hit hospitals serving the poor, By Jordan Rau, December 19, 2011, Washington Post: “James Breedin cannot keep track of how often he has been admitted to Howard University Hospital for heart problems. ‘It’s been so many,’ said Breedin, a 75-year-old disabled former truck driver from Northeast Washington. One reason for his frequent returns, he says, is that he often can’t afford the medications his doctor prescribes, ’so I have to do without.’ Another is that he fears exercising outside because of neighborhood violence. Medicare is preparing to penalize hospitals with frequent potentially avoidable readmissions, which by one estimate costs the government $12 billion a year. Medicare’s aim is to prod hospitals to make sure patients get the care they need after discharge. But this new policy is likely to disproportionately affect hospitals that treat the most low-income patients, according to a Kaiser Health News analysis of data from the Centers for Medicare & Medicaid Services…”

• Bigger share of state cash for Medicaid, By Michael Cooper, December 13, 2011, New York Times: “Medicaid has steadily eaten up a growing share of state budgets over the past three years, while education has been getting a smaller slice of the pie. That is one of the changes that the lingering economic downturn and the changing American economy have wrought on state finances, according to an analysis of state spending over the last few years released Tuesday by the National Association of State Budget Officers…”
• State Medicaid spending soars, By Lisa Lambert, December 14, 2011, Chicago Tribune: “Spending by U.S. states on Medicaid, the healthcare program for the poor, soared last year and will likely continue growing despite measures to contain costs, according to a report released on Tuesday. Total Medicaid spending, excluding administrative costs, likely reached $398.6 billion in fiscal 2011, which ended in June for most states. That was up 10.1 percent from the year before, when spending rose 6 percent, the National Association of State Budget Officers reported. Medicaid was nearly one-quarter of all state expenditures in fiscal 2011, compared to elementary and secondary education, which accounted for 20 percent of all spending…”
• Medicaid money for Texas to jump, By Don Finley, December 13, 2011, San Antonio Express-News: “The federal government Monday granted Texas a waiver that could mean billions more in Medicaid dollars to hospitals over the next few years, in return for having them work together to provide better care for the poor. In Bexar County, that could mean new money to help keep the mentally ill from overusing crowded hospital emergency rooms, among other new services, one local official said. At the same time, federal officials slapped down a request from Texas to deny Medicaid patients access to family planning centers such as Planned Parenthood that also provide abortions - a plan that had drawn the anger of family planning advocates…”
• Medicaid waiver could be boon for Texas hospitals, By Don Finley, December 12, 2011, Houston Chronicle: “The federal government on Monday granted Texas a waiver that could mean billions more in Medicaid dollars to hospitals over the next few years in return for having them work together to provide better care for the poor…”
• Studies point to flaws in Florida’s Medicaid managed care, By Christine Vestal, December 14, 2011, Stateline.org: “Like many other states in fiscal duress, Florida sliced a large portion of its Medicaid budget this fiscal year, primarily by cutting payments to hospitals, nursing homes and other health care providers. Next year, Governor Rick Scott wants to double the size of reductions to the federal-state program - again by cutting provider fees. Within the next two years, however, the Republican governor expects to shave billions from the state budget by letting private health plans take over the care of all of Florida’s Medicaid patients - more than 3 million people. Scott’s plan is a statewide expansion of a controversial five-county managed care pilot started by Republican former Governor Jeb Bush in 2006. The state Medicaid office sought approval for the plan in August and a decision by the U.S. Department of Health and Human Services is expected soon…”
• Gov. Rick Scott’s proposed budget includes $2.1 billion cut in Medicaid, By Matt Dixon, December 12, 2011, Florida Times-Union: “When Gov. Rick Scott unveiled his proposed $66.4 billion budget last week, many people in the capital and around the state cast it as schools versus hospitals. Scott’s spending plan injected public education with a roughly $1 billion increase but cut $2.1 billion in reimbursements for Medicaid. The cut prompted a fast pushback from the Safety Net Alliance of Florida, a lobbying group that represents 15 of the state’s biggest hospitals. It estimates the cuts would cost its members $1.4 billion…”
• Maine Medicaid deficit mainly due to budget miscalculations, By John Richardson, December 13, 2011, Portland Press Herald: “A $120 million budget deficit projected for the fiscal year that began July 1 has set off an ideological debate over the future of Maine’s Medicaid program. The deficit itself, however, is mostly the result of a series of technical budgeting miscalculations, according to a report prepared by the LePage administration. Problems with a new claims processing system, a loss of federal funds that wasn’t accounted for, and a failure to budget for increases in federal Medicare premiums are among the biggest causes…”
• Proposed Medicaid cuts draw big protests in Maine, By John Gramlich, December 15, 2011, Stateline.org: “Earlier this year, it was Arizona that drew national attention for removing tens of thousands of its citizens from the Medicaid rolls. Now, Maine Governor Paul LePage wants to do the same, saying the state-federal health insurance program is becoming unsustainable. LePage is pushing a proposal that would eliminate 65,000 Mainers from Medicaid, as the Bangor Daily News reports. At a hearing on the proposal Wednesday (December 14), hundreds of protesters converged on the State House to voice their disapproval of the plan, which seeks to close a $220 million shortfall in the state health and human services budget…”
• Report on R.I’s Global Medicaid Waiver finds $22M in savings, By Richard Asinof, December 14, 2011, Providence Business News: “The long-awaited report by the Lewin Group on Rhode Island’s Global Medicaid Waiver was released on Dec. 13, finding that some $22.9 million in savings had been created over three years, far below the $100 million in savings claimed by Gary Alexander, former Secretary of the R.I. Office of Health and Human Services under former Gov. Donald L. Carcieri’s administration…”
• Pa.’s drop in Medicaid rolls stirs controversy, By Don Sapatkin, December 15, 2011, Philadelphia Inquirer: “Since August, the Corbett administration has cut off more than 150,000 people - including 43,000 children - from medical assistance in a drive to save costs. That purge far exceeds what any other state has tried, health policy experts say, and officials may be walking a fine line between rooting out waste and erecting barriers to care for the poor and disabled. When most states were experiencing flat or rising Medicaid enrollment from the economic downturn, stepped-up eligibility reviews in Pennsylvania began producing a decline over the summer. The pace of cuts picked up in November, with 90,000 cases, or 4 percent, dropped in a single month. In New Jersey, enrollment increased by 391 the same month…”

• Optional Medicaid benefits face state cuts, By Phil Galewitz, October 23, 2011, USA Today: “States are using a variety of strategies to control rising Medicaid costs even as they look ahead to a massive expansion of the state-federal health insurance program for the poor beginning in 2014. The weak economy is driving more jobless Americans into Medicaid, increasing enrollment at the same time that medical costs keep going up. To deal with the higher costs, states are pushing Medicaid recipients into managed-care plans run by private insurers, cutting reimbursement rates to hospitals and doctors and reducing benefits…”
• More states limiting Medicaid hospital stays, By Phil Galewitz, October 23, 2011, USA Today: “A growing number of states are sharply limiting hospital stays under Medicaid to as few as 10 days a year to control rising costs of the health insurance program for the poor and disabled. Advocates for the needy and hospital executives say the moves will restrict access to care, force hospitals to absorb more costs and lead to higher charges for privately insured patients. States defend the actions as a way to balance budgets hammered by the economic downturn and the end of billions of dollars in federal stimulus funds this summer that had helped prop up Medicaid, financed jointly by states and the federal government…”

Medicaid expansion seen covering nearly all state prisoners, By Christine Vestal, October 18, 2011, Stateline.org: “The federal health law’s controversial Medicaid expansion is expected to add billions to states’ already overburdened Medicaid budgets. But it also offers a rarely discussed cost-cutting opportunity for state corrections agencies. Starting in 2014, virtually all state prison inmates could be eligible for Medicaid coverage of hospital stays-at the expense of the federal government. In most states, Medicaid is not an option for prison inmates. But a little known federal rule allows coverage for Medicaid-eligible inmates who leave a prison and check into a private or community hospital. Technically, those who stay in the hospital for 24 hours or more are no longer considered prison inmates for the duration of their stay…”

• Some states seek flexibility to push health-care overhaul further, By Sarah Kliff, October 16, 2011, Washington Post: “As far as health-reform boosters go, Oregon Gov. John Kitzhaber is among the most stalwart. ‘We want to show that health reform is something real, that it actually works,’ he said. ‘Oregon is a place that can actually make it happen.’ His state has aggressively implemented the health overhaul Congress passed last year, taking more than $100 million in federal funding to do so. But at the same time, the health-care law puts Kitzhaber (D) in a bind. This year, Oregon passed its own plan, which starts with changing how it pays doctors and eventually ends with allowing public employees to enroll in Medicaid, the federal insurance program for low-income Americans. There’s just one big obstacle: What Oregon wants to do would require the Obama administration to waive integral pillars of its signature legislative accomplishment…”
• Administration seeks to roll back hospital rules, By Robert Pear, October 18, 2011, New York Times: “The Obama administration moved Tuesday to roll back a number of rules governing hospitals and other health care providers after concluding that the standards were obsolete or overly burdensome to the industry. Among other things, the proposals would allow hospitals to save money by sometimes using qualified nurse practitioners and physician assistants in place of better-paid doctors, allowing doctors to focus more on patients and helping address ‘impending physician shortages.’ Kathleen Sebelius, the secretary of health and human services, said the proposed changes would save providers nearly $1.1 billion a year without creating any ‘consequential risks for patients.’ The proposed rules would apply to more than 6,000 hospitals…”
• ‘Supercommittee’ decision may lead to cuts funding for public health initiatives, By Marilyn Werber Serafini, and Mary Agnes Carey and Kaiser Health News, October 16, 2011, Washington Post: “Federal funding for medical research, disease prevention and a host of public health initiatives could be sharply reduced if the congressional ’supercommittee’ fails to agree on a deficit-reduction package, triggering automatic cuts. Public attention has largely focused on possible cuts to entitlement programs for seniors and the poor, Medicare and Medicaid, but health advocates are raising an alarm about many other smaller programs they say need to be protected…”

Study: Worst hospitals treat larger share of poor, By Carla K. Johnson (AP), October 5, 2011, Salt Lake Tribune: “The nation’s worst hospitals treat twice the proportion of elderly black patients and poor patients than the best hospitals, and their patients are more likely to die of heart attacks and pneumonia, new research shows. Now, these hospitals, mostly in the South, may be at higher risk of financial failure, too. That’s because the nation’s new health care law punishes bad care by withholding some money, says the lead author of the study published Wednesday in the journal Health Affairs…”

• Poor, uninsured hit hardest by closing of trauma centers nationwide, By Ellen Kleinerman, October 5, 2011, Cleveland Plain Dealer: “The shuttering of trauma centers across the country since 2001 has had a greater impact on communities with black, Hispanic, elderly, uninsured and poor people, according to a study released Wednesday. Researcher Dr. Renee Yuen-Jan Hsia said the closings — mostly in urban areas — were due to the high cost of trauma care, rising numbers of uninsured patients and cuts in Medicare payments…”
• Study finds nearest trauma center is now farther away for 1 in 4 Americans, Associated Press, October 5, 2011, Washington Post: “One hour can spell the difference between life and death for victims of severe injury, but about a quarter of Americans now have to travel farther to reach the nearest hospital trauma center, a study published Wednesday concludes. The reason: Hundreds of trauma centers have closed over the past two decades. Sixty-nine million people had to travel farther to reach a trauma center in 2007 than in 2001, according a study in the journal Health Affairs…”

• State decides what’s not an emergency, By Jordan Schrader, September 26, 2011, Tacoma News Tribune: “State government is about to start refusing to pay for repeat visitors to emergency rooms whose conditions don’t truly rise to the level of emergencies. The trouble is all in how you define an emergency. Starting Saturday, Medicaid won’t pay for more than three ER visits in a year for a patient’s nonemergency conditions as defined by the state. A list of more than 700 diagnoses put into that category has drawn fire from hospitals and doctors’ groups over inclusions whose symptoms seem awfully similar to emergencies…”
• Wisconsin starts publishing Medicaid cut proposals, By Scott Bauer (AP), September 27, 2011, Sheboygan Press: “Gov. Scott Walker’s administration unveiled a website Monday that includes a handful of Medicaid cost-savings proposals intended to help it reach required cuts of about $444 million over the next two years. But there’s a long way to go. Most of what was released was either already known about or would make little progress toward what needs to be cut. Only three of the six areas of savings detailed Monday had not been previously announced. Those three total $6 million in savings in state money, just 3 percent of the $181.8 million that must be found under the two-year budget that took effect in July. The total amount of unspecified cuts that must be found, including federal funding and other sources, is $444 million…”

Child abuse rose during recession, research says, By Lindsey Tanner (AP), September 19, 2011, Houston Chronicle: “An increase in child abuse, mostly in infants, is linked with the recent recession in new research that raises fresh concerns about the impact of the nation’s economic woes. The results are in a study of 422 abused children from mostly lower-income families, known to face greater risks for being abused, and the research involved just 74 counties in four states. But lead author Dr. Rachel Berger of Children’s Hospital of Pittsburgh said the results confirm anecdotal reports from many pediatricians who’ve seen increasing numbers of shaken baby cases and other forms of brain-injuring abuse. Berger decided to study this type of injury, known as abusive head trauma, after noticing an increase at her own hospital from late 2007 through June 2009. Her hospital averaged 30 cases per year during those recession years versus 17 yearly before 2007…”

After the hospital, a haven for homeless patients to recuperate, By Anna Gorman, August 28, 2011, Los Angeles Times: “A taxi dropped off Kim McAuliffe, clutching a plastic bag of medications, at a Los Angeles motel. She had just been discharged from Garfield Medical Center and had nowhere to go. ‘The hospital sent you here to rest after you’ve been sick,’ Roy Kaufman, a case coordinator, told her as she slumped into a chair. ‘We’re gonna take care of you.’ Everyone here has been in a hospital, is ill and homeless. Outside, the place looks like a standard motel, with a sign advertising color TV and air conditioning. Inside, nurses help homeless patients change bandages, take medication and recover from surgeries. Opened 10 months ago by the nonprofit Illumination Foundation, the Recuperative Care Center has 20 motel beds where homeless patients with acute illnesses or injuries recover after being released from local hospitals. The program and others like it dramatically reduce costly hospital stays and emergency room visits - often funded by taxpayers - and give hospitals a place to safely release patients without leaving them on the streets…”

• Ruling: AHCCCS copays break law, By Mary K. Reinhart, August 25, 2011, Arizona Republic: “A federal appeals court ruled Wednesday that mandatory copayments charged to Arizona’s poorest residents violate federal law. The three-judge panel of the 9th U.S. Circuit Court of Appeals said federal health officials failed to show how the copays, imposed in November after a seven-year court battle, served any purpose besides cutting the state’s Medicaid budget. Federal law gives the U.S. Health and Human Services secretary discretion to approve state Medicaid ‘waivers’ as long as the programs have a ‘research or demonstration value.’ Raising copayments for more than 200,000 of Arizona’s poorest residents and making them mandatory, the judges said, helped balance the state budget but didn’t meet that federal standard…”
• Illinois Medicaid’s managed care effort stumbles, By Judith Graham, August 26, 2011, Chicago Tribune: “It can take years for people with cerebral palsy, autism, schizophrenia or Down syndrome to find trusted physicians to oversee their health. Now, families and advocates say, those medical relationships are being threatened as Illinois rolls out a new program of HMO-style care for people with serious disabilities. Many doctors and hospitals are refusing to join the new Medicaid program, which the state hopes will better coordinate care and lower costs for some of its neediest recipients. The providers’ rationale: They dislike the bureaucratic hassles and cost-cutting measures associated with managed care. The ranks of those who have said no, for the moment, include prominent medical centers and physician practices with a long track record of serving the disabled, among them Northwestern Memorial Hospital, Rush University Medical Center, the University of Chicago Medical Center, Children’s Memorial Hospital and Loyola University Health System. Because of the situation, hundreds if not thousands of vulnerable, chronically ill individuals are being forced to find new doctors, some of whom appear ill-equipped to handle their needs, according to consumer advocates and families…”

Hospitals seek more ER patients even as Medicaid tries to lessen demand, By Phil Galewitz, August 22, 2011, Washington Post: “Complaining of abdominal discomfort and chronic bronchitis, 22-year-old Toshia Johnson, an unemployed mother on Medicaid, went to a hospital emergency room in Bend, Ore., more than two dozen times in the year that ended in June 2010. She was never admitted to the hospital and used the ER for routine care because, she says, it’s near her home and the care was free. But in the first six months of this year, after entering a state-funded program designed to reduce unnecessary ER use by Medicaid patients in central Oregon, Johnson has gone to the ER just once, after breaking her tailbone. In the first half of this this year, ER visits by the 400 patients in this program have declined by more than half from the same period last year, saving Medicaid $1 million, officials say. Efforts to reduce unnecessary ER visits by patients in Medicaid, the joint state-federal health program for the poor and disabled, are proliferating as states search for ways to control the soaring costs of the program. But state officials complain that their efforts are sometimes hampered by hospitals’ aggressive marketing of ERs to increase admissions and profits…”

Demand for safety-net care remains high in Massachusetts, By Noam N. Levey, August 8, 2011, Los Angeles Times: “Massachusetts, whose 2006 healthcare overhaul provided a template for the landmark national law signed by President Obama last year, has already demonstrated that it is possible to achieve almost universal health coverage. Now, the trailblazing state is providing another clue about what may happen when the federal government begins guaranteeing health insurance for all citizens starting in 2014. Massachusetts community health centers and so-called safety-net hospitals - originally created to serve the poor and uninsured - have seen no let-up in demand, even after the state’s reforms, according to new research published Monday in the Archives of Internal Medicine…”

‘Charity’ care, bad debt rise for Iowa hospitals, By Rod Boshart, August 2, 2011, Cedar Rapids Gazette: “The prolonged U.S. economic downturn has contributed to a rise in the level of uncompensated ‘charity care’ and unpaid medical debts that Iowa hospitals have incurred in recent years, officials said Tuesday. Overall, the 118-member Iowa Hospital Association provided more than $850 million worth of care last year for which the facilities were not fully compensated, association spokesman Scott McIntyre said. That level, based on a member survey, was up $54 million, or 6.8 percent, from 2009. The total stood at $252 million in 2000, he said…”

A rising hunger among children, By Kay Lazar, July 28, 2011, Boston Globe: “Doctors at a major Boston hospital report they are seeing more hungry and dangerously thin young children in the emergency room than at any time in more than a decade of surveying families. Many families are unable to afford enough healthy food to feed their children, say the Boston Medical Center doctors. The resulting chronic hunger threatens to leave scores of infants and toddlers with lasting learning and developmental problems…”

• Study shows Medicaid kids are denied medical care, By Lindsey Tanner (AP), June 16, 2011, USA Today: “Children on public insurance are being denied treatment by doctors at much higher rates than those with private coverage, according to an undercover study that had researchers pose as parents of sick kids seeking an appointment with a specialist. Snubbed even by specialists whose offices supposedly accept public insurance patients, these kids also had to wait much longer to see a doctor. Low Medicaid reimbursements are the likely reason, the study authors said. The study was done in Cook County, Ill., the nation’s second-most populous county which includes Chicago, but the researchers and others say the results likely reflect practices around the country…”
• Penn study finds doctors delaying or rejecting specialty care for publicly insured children, By Marie McCullough, June 16, 2011, Philadelphia Inquirer: “A University of Pennsylvania study in which callers posed as mothers seeking pediatric specialty care found that two-thirds of publicly insured children were refused a doctor’s appointment, compared with only 11 percent of privately insured children. Even the low-income children who were not rejected had to wait an average of 42 days for appointments for urgent conditions such as diabetes, seizures, asthma, or a bone fracture - 22 days longer on average than children with private insurance…”

2 Illinois hospitals on brink of closure illustrate pressures on US health care safety net, By Carla K. Johnson (AP), May 9, 2011, Washington Post: “Two charity hospitals in Illinois are facing a life-or-death decision. There’s not much left of either of them - one in Chicago’s south suburbs, the other in impoverished East St. Louis - aside from emergency rooms crowded with patients seeking free care. Now they would like the state’s permission to shut down. The institutions, which have served low-income people in the state for more than 100 years, represent a significant development that’s gone largely unnoticed as the nation climbs out of the recession. Many charity hospitals, already struggling with rising costs, are on the brink of failure because of looming budget cuts, increasing numbers of uninsured patients and a slow economic recovery…”

Rule would discourage states’ cutting Medicaid payments to providers, By Robert Pear, May 2, 2011, New York Times: “In a new effort to increase access to health care for poor people, the Obama administration is proposing a rule that would make it much more difficult for states to cut Medicaid payments to doctors and hospitals. The rule could also put pressure on some states to increase Medicaid payment rates, which are typically lower than what Medicare and commercial insurance pay. Federal officials said Monday that the rule was needed to fulfill the promise of federal law, which says Medicaid recipients should have access to health care at least to the same extent as the general population. ‘We have a responsibility to ensure sufficient beneficiary access to covered services,’ the administration said in issuing the proposal, to be published Friday in the Federal Register. In many parts of the country, Medicaid recipients have difficulty finding doctors who will take them because Medicaid payment rates are so low…”

Hospitals, state officials agree to provider fee to help shore up Medicaid in Colo., By Michael Booth, February 4, 2011, Denver Post: “State health officials and hospital leaders have agreed on a proposed $50 million transfer of provider fees to shore up basic Medicaid in Colorado, while federal officials on Thursday urged states to also consider cuts in optional benefits to balance their threatened Medicaid budgets. Hospitals and advocates for the poor hail the first year of the provider fee - hospitals taxing themselves to get more Medicaid funding through a federal match - as a success in expanding insurance coverage in Colorado. ‘We pitched it as a win-win-win for consumers, hospitals and the state, and I think it’s absolutely proven to be that,’ said Cody Belzley, vice president of the Colorado Children’s Campaign and an architect of the fee in the administration of former Gov. Bill Ritter. It allowed the state to expand insurance last year to 30,000 people who previously made too much to qualify…”

• For governors, Medicaid looks ripe for slashing, By Kevin Sack, January 28, 2011, New York Times: “Hamstrung by federal prohibitions against lowering Medicaid eligibility, governors from both parties are exercising their remaining options in proposing bone-deep cuts to the program during the fourth consecutive year of brutal economic conditions. Because states confront budget gaps estimated at $125 billion, few essential services - schools, roads, parks - are likely to escape the ax. But the election of tough-minded governors, the evaporation of federal aid, the relentless growth of Medicaid rolls and the exhaustion of alternatives have made the program, which primarily covers low-income children and disabled adults, an outsize target…”
• Medicaid cuts could lead to higher taxes, insurance premiums, By Tim Eaton, January 28, 2011, Austin American-Statesman: “Even if you don’t rely on Medicaid, Texas lawmakers’ proposed cuts in the health care program could cost you money. Cutting Medicaid could have outcomes beyond fewer services for the poor, several local officials in the health care industry said. Notably, taxpayers in Central Texas could end up with increased local taxes and higher insurance premiums, according to several Central Texas health care professionals. Tom Banning, the CEO for the Texas Academy of Family Physicians, said the proposed cuts don’t equate to savings. Rather, there is simply a shuffling of expenses. ‘This has the potential to be the biggest cost shift to local governments that Texas has ever seen,’ Banning said. The two largest hospital groups in Austin echoed those concerns…”

• Hospitals, poor patients face new costs, By Kay Lazar and Stephen Smith, January 27, 2011, Boston Globe: “Payments to hospitals and other health care providers would be slashed and low-income patients served by Medicaid would have to pay higher copayments under the spending plan Governor Deval Patrick proposed yesterday for the next budget year. But the biggest savings in the $10 billion program that serves 1.2 million residents would come from revising and rebidding Medicaid contracts to encourage health care providers to work together to drive down costs. With health care spending, including Medicaid, now making up 39 percent of the state budget, Patrick said it was time to take aggressive action to halt the relentless trend upward…”
• Minnesota health CEOs taking a whack at Medicaid, By Warren Wolfe, January 26, 2011, Minneapolis-St. Paul Star Tribune: “Concerned that the Legislature and governor might get it wrong, CEOs from seven major health plans and providers have drawn up their own plan to streamline Minnesota’s massive Medicaid program — and carve $1.8 billion from the projected $6.2 billion deficit. The plan is sure to draw political fire. It suggests up to $170 million in cuts to state-funded services that help keep the elderly and disabled out of institutions, for example, and captures $280 million in higher taxes on tobacco and alcohol. Nonetheless, its influential authors and specific targets will make it part of the debate as lawmakers grapple with a state budget in which health care consumes 30 percent of all spending…”
• Gov. Steve Beshear wants Medicaid funds shifted to avoid shortage, By Deborah Yetter, January 19, 2011, Louisville Courier-Journal: “Seeking to prevent deep cuts in services, Gov. Steve Beshear said Wednesday that he will ask lawmakers to shift $166.5 million from next year’s Medicaid budget into the current fiscal year. The maneuver would allow Kentucky to draw more federal matching money for Medicaid from federal stimulus funds, though it only postpones the need to achieve savings or make cuts in the program. The stimulus funds expire June 30, which is also the end of the current fiscal year. If nothing is done, Kentucky’s $6 billion-a-year Medicaid program could wind up as much as $600 million short this year, the governor said. And that, he said, could lead to ‘devastating’ cuts of up to 30 percent in the federal-state health plan for the poor and disabled that serves more than 800,000 people…”

• In places with scarce prenatal care, midwives deliver maternity solution, By David Wahlberg, November 23, 2010, Wisconsin State Journal: “The people who live in and around this small city where the foothills meet the plains can count on an important service: The hospital delivers babies. One reason maternity care is available in New Mexico’s San Miguel County, where the poverty rate is nearly twice the national average, is the presence of midwives, who oversee most of the births. Rural hospitals in New Mexico, Wisconsin and across the country have dropped deliveries in recent years because they can’t find enough doctors to do them. But the arrangement in Las Vegas, where only one doctor does obstetrics full time but three nurse midwives attend births, suggests midwives can help maintain maternity care in rural areas…”
• High deductibles mean less medical care for lower-income families, survey finds, By Eryn Brown, November 23, 2010, Los Angeles Times: “Lower-income families with high-deductible insurance policies are more likely to delay or forego medical care because of cost than higher-income families, reported a study published Monday in the Archives of Internal Medicine. The findings are not surprising. But coming at a time when policymakers are working to keep healthcare costs down and outcomes up — calibrating insurance plans to motivate consumers to be choosier about the medical services they purchase, yet still seek enough care to remain healthy — the results could yield useful ideas, the researchers wrote…”

• Medicaid squeeze: Shrinking federal reimbursements cause doctors to limit care to needy, By Louise Knott Ahern, November 14, 2010, Lansing State Journal: “In a 16-county swath across Northern Michigan, pregnant women have to drive an hour or more to reach a hospital where they can deliver their babies. From Cheboygan to West Branch to Clare, hospitals have been closing their obstetrics units since last summer in a startling domino effect that has health care activists worried about care availability for rural mothers and babies. But they’re equally alarmed about the reason behind the hospital closures. The hospitals blame, in large part, Medicaid. And health care reform advocates say that reflects a broader problem. Since 2002, the state has been chipping away at how much it reimburses doctors and hospitals for treating Medicaid patients to a point where some say they’ve reached a painful bottom-line reality: It has become too expensive to treat poor people…”
• Conservative legislators in Texas seek to opt out of Medicaid, By Dave Montgomery, November 13, 2010, Fort Worth Star-Telegram: “A push from conservative legislators for Texas to opt out of Medicaid is stirring alarm among healthcare providers and nursing homes, which say the potential loss of billions of federal dollars could drastically undercut efforts to provide healthcare for the poor. The opt-out plan has quickly emerged as another high-profile topic for the 2011 Legislature, pushed by Gov. Rick Perry and a number of conservative lawmakers who believe that Texas can provide health coverage to the indigent more efficiently with a state-run plan free of federal mandates…”

For poor, health care at extremes, By Warren Wolfe, September 19, 2010, Minneapolis-St. Paul Star Tribune: “Perched on an exam table at Hennepin County Medical Center in Minneapolis, Ron Beasley, 46, sits at one end of the spectrum under Minnesota’s revamped health care program for the poorest adults, General Assistance Medical Care (GAMC). Hospitalized four times this year, he now gets intensely coordinated care from a medical team in a new clinic that seeks out and treats some of the state’s most difficult patients. The goal: Improve his health, avoid a medical crisis and save the health care system a bundle. At the other end of the spectrum is Joe ‘Smokey Joe’ Johnson, 53, a grizzled veteran of the Twin Cities streets who is pretty sure he’s got diabetes, ’some kind of breathing problem and a bum leg.’ He hasn’t had a regular doctor or clinic for years and doesn’t want one now. ‘When I get sick, I just go to whatever ER I’m closest to. I get to decide.’ The two Minneapolis men illustrate the extremes of care under the program, which was the subject of a fierce tug-of-war between legislators and Gov. Tim Pawlenty last spring and is just now taking full form in Minnesota hospitals. For thousands of the poorest and sickest Minnesotans in GAMC, the type of health care they get depends more on geography and choice than on how sick they are…”

Fewer to get care with GAMC alteration, By Warren Wolfe, September 1, 2010, Minneapolis-St. Paul Star Tribune: “Because of a change made by state officials Wednesday, about 2,500 fewer people will get coordinated care in medical clinics taking part in a program for Minnesota’s poorest and sickest patients. Instead, those patients will need to find clinics that offer charity care, wait for a medical emergency so they can get free care in any hospital emergency room, or go without. A reduction in the overall number of people on General Assistance Medical Care (GAMC) led the state on Wednesday to reduce the maximum number of patients who may choose coordinated care offered by four Twin Cities hospitals. As a result, three of the hospitals now are well above their GAMC patient limits, leaving only Hennepin County Medical Center in Minneapolis with open slots. It has about 3,750 slots remaining, while 18,000 patients have not yet chosen a coordinated care program…”

GAMC health plan hits new snag, By Warren Wolfe, August 23, 2010, Minneapolis-St. Paul Star Tribune: “State officials said Monday they might retool the payment formula for hospitals participating in an experimental new health plan for some of the state’s poorest residents — a further sign that the revised General Assistance Medical Care (GAMC) program launched last spring is not working out the way authorities had hoped. The discussions began because Hennepin County Medical Center (HCMC) in Minneapolis has had a smaller percentage of potential patients enroll than the other three participating hospitals and, as a result, is getting paid more than twice the amount per patient…”

Rural hospitals face challenges across the state, By Charles Oliver, August 22, 2010, Dalton Daily Citizen: “The economic downturn, cuts in state and federal health care programs, and attempts by private businesses to rein in their own health care costs have combined to create a ‘perfect storm’ that threatens small rural hospitals across the state, according to Jimmy Lewis, CEO of HomeTown Health, which represents 55 rural hospitals in Georgia including Murray Medical Center. ‘We could wake up tomorrow and have 10 hospitals about to close,’ said Lewis. Forty-one Georgia hospitals have closed since 1980, according to the Georgia Hospital Association, many of them small rural hospitals. The problem that rural hospitals face is that their ‘payer mix’ is typically heavy in patients on Medicare and Medicaid and those without insurance…”

For the homeless, federal changes promise better access to health care, By Mary Agnes Carey and Andrew Villegas, August 20, 2010, Washington Post: “Homeless and unemployed, Tianne Hill said she dreads getting mail at the city shelter on Guilford Avenue where she lives because it often includes medical bills she can’t pay. The 40-year-old former waitress and short-order cook owes about $6,000 for abdominal surgery. She’s expecting another bill soon for emergency treatment of a seizure. And she has other conditions that require expensive care: asthma, arthritis, anxiety and depression. Like many other homeless people, Hill is uninsured and ineligible for Medicaid, the state-federal program that covers millions of other poor Americans. But beginning in 2014, Medicaid greatly expands under the new health-care law to include adults without children, who generally have been excluded. The Medicaid expansion also will enable agencies that serve the homeless to divert resources now spent on medical care to other services such as finding housing and jobs. The new law provides another boost through a five-year, $11 billion expansion of the community health center system that treats many in this population…”

UCSF study finds big jump in ER visits, By Victoria Colliver, August 11, 2010, San Francisco Chronicle: “Emergency room visits to U.S. hospitals increased more than 23 percent from 1997 to 2007 - double what researchers expected the rise would be based on population growth, according to a UCSF study released today. Total annual visits to the country’s emergency departments rose from 94.9 million in 1997 to an estimated 116.8 million over the next decade, the study found. Visit rates for adults on Medicaid accounted for the jump, while rates for adults with private insurance and those on Medicare showed no significant change. Relatively low reimbursements to physicians who care for patients on Medicaid, the federal-state health program for the poor who meet certain criteria, were believed to be a key factor behind the increase…”

• No big increase in health charity with job losses, By Guy Boulton, August 8, 2010, Milwaukee Journal Sentinel: “Tens of thousands of people in the Milwaukee area have lost their jobs since the start of the recession, yet the increase has not resulted in a surge in charity care by health care systems in the region. The amount of free and discounted care provided by the health systems has been stable when calculated as a percentage of patient revenue, even as the economy struggles through the worst downturn since the Great Depression. The amount of bad debt also has not risen noticeably. That surprises some health care executives, who expected a sharp increase in charity care and bad debt expense at the recession’s start…”
• Uninsured patients overwhelm Denver Health clinics, By Jennifer Brown, August 9, 2010, Denver Post: “A rising number of needy patients without health insurance is overwhelming community clinics in Denver, leaving some sick people to wait up to four months to see a family doctor. When new patients call one of Denver Health Medical Center’s eight clinics across the city, they are transferred to a downtown call center where they are put on a waiting list - a list that now contains 3,500 names. Patients can end up on the list ‘even if they are dying of something - that’s the horror,’ said Dr. Lara Penny, a family doctor at Denver Health’s Montbello clinic. The facility is so busy, the hospital system is setting up modular units to accommodate patients until a new building opens in January 2012 with the help of federal stimulus money. The county’s safety-net hospital, Denver Health treats anyone with an emergency, regardless of whether they can pay. That means a person injured in a car wreck or who has a heart attack will get care. But if that person also is diagnosed with diabetes or heart disease, getting a follow-up appointment with a primary-care doctor can take months…”

Funding cuts strain health plan for poor, By Warren Wolfe, August 6, 2010, Minneapolis-St. Paul Star Tribune: “In a fragile new health program that already offers limited and uneven care to 30,000 of the poorest and sickest Minnesotans, the choices for comprehensive medical care will drop today from four hospitals to three — and soon may plunge to one. North Memorial Medical Center in Robbinsdale confirmed that it would stop taking new patients in General Assistance Medical Care (GAMC) at the end of Friday after surpassing its 1,977-patient limit on enrollments. Within three weeks, University of Minnesota Medical Center/Fairview in Minneapolis is likely to hit its enrollment cap, followed shortly by Regions Hospital in St. Paul, officials said. That will leave only Hennepin County Medical Center in Minneapolis for people who want to enroll in GAMC or for those already in the program who seek comprehensive care. If all four hospitals hit their limits, the only medical care available to GAMC patients will come from hospital emergency rooms or clinics that offer charity care…”

Serious injuries worse for uninsured, By Henry L. Davis, July 26, 2010, Buffalo News: “Federal law prohibits hospitals from treating uninsured trauma patients any differently than patients with insurance. Yet studies in recent years have exposed a big disparity: Patients who lack insurance are much more likely to die from car accidents, gunshot wounds and other serious injuries than those who arrive at the hospital with coverage. The latest research comes from a University at Buffalo analysis of 191,666 patients, ages 18 to 30, who visited 649 trauma centers from 2001 to 2005 for blunt and penetrating trauma injuries. Blunt trauma includes injuries mainly from motor vehicle accidents, followed by such incidents as falls and assaults, while penetrating trauma consists mainly of gunshot wounds and, to a lesser extent, injuries from stabbings.  For blunt trauma, uninsured patients were 1.8 times more likely to die, even after controlling for age, sex, race and severity of injury, according to the researchers, who presented their results recently at the Society for Academic Emergency Medicine annual meeting. If patients lacked insurance, they were 2.6 times more likely to die from penetrating trauma injuries…”

Feds OK plan to let hospitals recoup Medicaid expense, By Catherine Candisky, July 15, 2010, Columbus Dispatch: “Federal regulators have approved a state plan to pay hospitals an additional $87 million this year for the care they provide to low-income Ohioans on Medicaid. The funds will be disbursed to hospitals by the end of this month. The bulk payment and a 5 percent increase in Medicaid reimbursement fees effective in October were included in last year’s state budget to let hospitals recoup some of the money they were losing through a new state franchise fee. The fee is projected to cost hospitals statewide $718 million over the two-year budget ending June 30, 2011. The two provisions aimed at offsetting that expense will let hospitals recoup $569 million, said Tiffany Himmelreich, spokeswoman for the Ohio Hospital Association…”

From rats to heaters, doctor-lawyer team fights barriers to family health care, By Lena H. Sun, May 26, 2010, Washington Post: “Thirteen-year-old Haji Conteh had all the irritating symptoms of seasonal allergies when her father took her to see a pediatrician at a D.C. clinic last summer. But when the doctor questioned Haji and her father, she began to suspect there might be a cause other than pollen for the girl’s sneezing and itchy eyes: the rats and mold in the family’s Northwest Washington apartment. The pediatrician didn’t have the time or expertise to probe more deeply. But she did refer the family to a specialist– not another doctor, but a lawyer. The family is among 1,400 referred by doctors and others at Children’s National Medical Center to the Children’s Law Center. As part of a medical-legal partnership that began in 2002, lawyers work alongside doctors at four District clinics run by the hospital. Their shared goal is to overcome legal and social challenges that threaten the care of their patients — low-income children, predominantly African American, and virtually all covered by Medicaid…”

Study: Uninsured don’t go to the ER more than insured, By Mary Brophy Marcus, May 20, 2010, USA Today: “A kiss gone awry isn’t the typical route that lands a person in the emergency room, but that’s just how Maggie Craytor ended up in the University of Virginia Medical Center’s emergency department in August. ‘She was running after her older brother Luke to give him a kiss, and she fell and got a cut right underneath her eye,’ says her mother, Allison. Maggie, now 4, needed two stitches. Her mother is glad the family had insurance to cover the costly emergency visit her pediatrician’s office recommended. The Craytors, a family of five with private health insurance, are just as likely to use the emergency room as people without insurance, according to a new report by the Centers for Disease Control and Prevention…”

Hospitals care for hundreds of Medicaid patients per year others won’t take, By Michael J. Berens, May 11, 2010, Seattle Times: “There are no bars on her window or locks on the door, yet Jeri Ringseth considers herself a prisoner. On Nov. 4, she was admitted to St. Joseph Medical Center in Tacoma with a diabetic blood-sugar imbalance, a life-threatening condition that over the years has caused both her legs to be amputated. She was well enough within days for release to a nursing home. Instead, she had to wait, and as of Tuesday - after 189 days at St. Joseph - she still waits. ‘Nobody wants me anymore,’ she says. Ringseth, 41, is a low-income patient who suffers from chronic disabilities. She’s too sick to care for herself and not well-off enough to pay for a private nursing home or other facility. She’s one of hundreds of Medicaid patients in Washington state each year who - despite no longer needing hospitalization - have occupied hospital rooms for a month or longer while trying to find a nursing home or other facility to take them in. A Seattle Times investigation has found at least 2,025 such cases from 2000 to 2008. Overall price tag: $461 million. Although written off as charity care, those costs are passed on to those who do pay for their care, according to the Washington State Hospital Association…”

• Legislators seek to expand Medicaid, By Warren Wolfe, May 10, 2010, Minneapolis-St. Paul Star Tribune: “Legislative conferees agreed Sunday that expanding Medicaid should be part of the eventual compromise they will take to the House and Senate as early as Monday in a package of health and human service measures to cut the state’s budget deficit. Gov. Tim Pawlenty has strongly opposed expanding Medicaid to cover health care for childless adults earning less than 75 percent of the poverty guideline. Even though it would bring in about $1 billion in federal money over the next three years, he argues that the state cannot afford to provide the required $1 billion match…”
• Nurses, doctors, hospitals urge shift to Medicaid, By Warren Wolfe, May 11, 2010, Minneapolis-St. Paul Star Tribune: “Leaders of the state’s hospital, nurse and doctors’ associations added their voices to a health care debate between Gov. Tim Pawlenty and DFL legislators Monday, urging the state to cover its poorest residents with the state-federal Medicaid health program rather than a slimmed-down state plan negotiated last month. With a week to go before the Legislature is to adjourn, the groups urged enactment of a bill supported by DFL leaders and opposed by Pawlenty that would shift about 37,000 patients from General Assistance Medical Care (GAMC) to Medicaid, called Medical Assistance (MA) in Minnesota…”

Comptroller: State overpays for Medicaid, By Cathleen F. Crowley, May 4, 2010, Albany Times Union: “The state Medicaid program overpaid hospitals $150 million, according to audits released Monday by the state comptroller’s office. Thomas P. DiNapoli blamed the payments on ‘pervasive problems’ with the state Department of Health’s billing system and policies. In one case, the state paid an Ohio hospital $1.5 million for a bone marrow transplant that should have cost $117,000, the audit said. Medicaid is the $45 billion public health insurance program for the poor and disabled. The state Department of Health, which oversees New York’s Medicaid, said many of the problems in the audit have already been fixed. The DOH also said that $53 million of the so-called overpayments identified are hypothetical because the figure is based on a proposed payment policy that would require legislative change…”

• States decide on running new pools for insurance, By Robert Pear, April 29, 2010, New York Times: “The fight over the new health care law shifted Thursday to the states, as some governors claimed federal money to run a new insurance pool for people with serious medical problems, while officials in other states said they would not operate the program. Friday is the deadline for states to tell the Obama administration whether they want to run the high-risk insurance pool for uninsured people with pre-existing conditions, or whether they will leave the task to Kathleen Sebelius, the secretary of health and human services…”
• New Colorado law to help insure 67,500 more, By Jennifer Brown, April 29, 2010, Denver Post: “Colorado can afford to add about 67,500 people to Medicaid and other government insurance next week, thanks to a new state law that requires hospitals to chip in toward the landmark initiative. Hospitals made their initial payments - and in return, received more state and federal cash to take care of needy patients - this month. The amount each hospital paid was worked out through a complicated formula that left some hospitals in the hole and others millions of dollars ahead of where they were before the new law. The state Department of Health Care Policy and Financing released a list of hospital winners and losers at The Denver Post’s request…”

• Deal on state health coverage for the poor is unraveling, By Tom Scheck, April 21, 2010, Minnesota Public Radio: “It looks like the deal to continue state-paid health care for Minnesota’s poorest residents is unraveling. The Hennepin County Board has rejected a contract with the state to have Hennepin County Medical Center take part in a new version of General Assistance Medical Care. Hennepin County Commissioner Peter McLaughlin said HCMC initially applied to treat the state’s poorest residents, but that was under the assumption that 16 other hospitals would also join in. To date, only five hospitals have applied, prompting concern that more and more GAMC patients would show up at HCMC for medical treatment…”
• HCMC could undo health care plan for poor, By Warren Wolfe, April 22, 2010, Minneapolis-St. Paul Star Tribune: “A delicate compromise to continue health coverage for about 37,000 poor Minnesotans, hammered out last month between DFL leaders and Gov. Tim Pawlenty, suffered a major blow Tuesday when Hennepin County commissioners rejected the state’s terms. While they didn’t rule out participation by their hospital, Hennepin County Medical Center (HCMC), commissioners said they need a better deal for taking on 10,000 or so poor patients in the revamped General Assistance Medical Care program, scheduled to start June 1. Without participation by HCMC, the biggest provider for these patients, the new program might fail. At least one other hospital said Wednesday that it would back out if Hennepin County does, and several outstate hospitals said last week they will not participate…”

• Fewer doctors, longer ER waits are expected, By Ken Alltucker, March 24, 2010, Arizona Republic: “Arizona hospitals say the Legislature’s steep cuts to health-care programs may trigger more hospital cuts and layoffs, longer emergency-room waits and a deepening doctor shortage. The budget cuts will eliminate health insurance for nearly 350,000 low-income adults and children enrolled in the state’s Medicaid program, leaving them few options for care. Hospital executives worry that they will have to absorb the cost and burden of providing treatment for the low-income residents and children until the more generous federal subsidies arrive in 2014 as part of the federal health-reform bill. Hospitals are required to provide care regardless of a patient’s ability to pay…”
• Arizona non-profit clinics fear lost funds, flood of uninsured patients, By Ginger Rough, March 24, 2010, Arizona Republic: “Arizona’s community health centers, a vital safety net for the uninsured and the working poor, are bracing for an onslaught of new patients and preparing to roll back their services after two state health-care programs were killed and the state’s Medicaid spending was slashed. New patients cut off from government insurance programs could flood the centers, and the centers would not have reimbursements from those programs to cover the full cost of providing care. The 16 federally qualified centers, which are non-profits and operate more than 130 clinics in mostly rural and underserved areas, rely mainly on state and federal insurance and federal grants to operate…”

When doctor visits lead to legal help, By Erik Eckholm, March 23, 2010, New York Times: “It was not the normal stuff of a pediatric exam. As a doctor checked the growth of Davon Cade’s 2-month-old son, he also probed about conditions at home, and what he heard raised red flags. Ms. Cade’s apartment had leaky windows and plumbing and was infested with roaches and mold, but the city, she said, had not responded to her complaints. On top of that, the landlord was evicting her for falling behind on the rent. Help came through an unexpected route. The doctor referred Ms. Cade to the legal aid office right inside the pediatric clinic at Children’s Hospital in Cincinnati. Within days, a paralegal had secured an inspection that finally forced the landlord to make repairs, and also got the rent reduced temporarily while Ms. Cade searched for less expensive housing. ‘It got done when the lawyers got involved,’ Ms. Cade said…”

Burden higher for nonprofit hospitals, Illinois Supreme Court says, By Bruce Japsen and Jason Grotto, March 19, 2010, Chicago Tribune: “An Illinois Supreme Court decision Thursday puts nonprofit hospitals on notice that they must provide an adequate amount of charity care to patients or risk losing significant tax exemptions. The decision, closely watched at a time when medical centers and the government are straining to cover health care costs for the poor, is a blow to the state’s hospital industry. It sets the stage for a potential debate about exactly how charitable hospitals must be, with some experts predicting that Springfield could seek to pass a law mandating the amounts. In the meantime, state officials indicated they could incorporate the court ruling into their assessments of whether to renew hospital tax exemptions. In its decision upholding a lower court ruling, the high court found that the Illinois Department of Revenue was correct in withdrawing Provena Covenant Medical Center’s property tax exemption in 2004 because the Urbana hospital failed to justify adequately the exemption through charitable giving…”

Budget cuts could hit low-income NJ residents, By Geoff Mulvihill (AP), March 15, 2010, Philadelphia Inquirer: “New Jersey’s days as a place where the government is unusually generous to the needy may be numbered as a new governor pushes wide-ranging spending cuts to solve a deep budget crisis. Gov. Chris Christie is set to unveil his first spending plan Tuesday after months of preaching shared sacrifice. From what he’s done so far, it’s clear that applies to lower-income people, too, in a state that’s among the most generous in the nation when it comes to unemployment benefits and taxpayer-funded health care for the working poor. Already, he has cut the state’s mass-transit subsidy and stopped enrolling some lower-income adults in a subsidized health insurance program. He’s also proposed reducing weekly unemployment checks and, even before he was sworn in, hinted that food banks could see their state aid cut and told hospitals their reimbursements for treating the indigent will be cut in June…”

• Medicaid cuts call health care for vulnerable Idahoans into question, By Colleen LaMay, March 3, 2010, Idaho Statesman: “No matter where you cut Medicaid, you are bound to slice into care that matters a great deal to some of the 213,000 people who rely on it for their health care. The Legislature’s Joint Finance-Appropriations Committee on Thursday will consider how to make up a $29 million shortfall in state funding for Medicaid for this year, as well as how and where to curb Medicaid to meet JFAC’s budget goals for 2011. Medicaid started its fiscal year in July with a budget of about $1.5 billion in federal and state funding. That dropped to $1.4 billion as the economic news became more grim…”
• Idaho lawmakers approve budget cuts for Medicaid, By Brian Murphy, March 4, 2010, Idaho Statesman: “Idaho legislative budget writers approved a Medicaid budget Thursday morning that forces the Department of Health and Welfare to finding savings of more than $47 million in the program and gives Gov. Butch Otter the authority to modify state statutes to keep the program in check. The entire Medicaid budget is $1.55 billion dollars, with $298 million coming from the General Fund. More than $1.5 billion of the budget comes from the federal government. Lawmakers expect $25 million to come from the Hospital Assessment Act, a bill that has yet to be introduced this session. Hospitals will pay the state in order to continue to keep its federal match. That still leaves more than $22 million in savings for the department to find…”
• State can’t cut Medi-Cal payments to hospitals, By Bob Egelko, March 4, 2010, San Francisco Chronicle: “A federal appeals court barred California on Wednesday from lowering Medi-Cal payments to doctors and hospitals by 5 percent and from cutting in-home care workers’ wages by nearly 20 percent, saying the state’s budget crisis doesn’t justify violating federal laws that protect the poor and disabled.In four rulings, the Ninth U.S. Circuit Court of Appeals in San Francisco rejected attempts by Gov. Arnold Schwarzenegger and the Legislature to reduce the state’s deficit by paying less to the health professionals who treat 6.6 million low-income Californians, and to hundreds of thousands of workers who care for some of the neediest…”

Bills stalled, hospitals fear rising unpaid care, By Reed Abelson, February 8, 2010, New York Times: “President Obama says he aims to keep trying. But what happens if the health care legislation cannot be revived, and tens of millions of uninsured Americans continue without coverage? For the nation’s hospitals, at least, the cost of doing nothing in Washington translates into tens of billions of dollars each year in medical bills that go unpaid by patients with little or no insurance. Nationwide, the cost of unpaid care for hospitals, which includes charity care as well as money that could not be collected from patients, was around $36 billion in 2008. It is expected to spiral higher. The number of people without insurance in this country could increase to as high as 58 million by 2014, from about 49 million now, according to an estimate by the Urban Institute. No wonder hospital systems like Park Nicollet Health Services near Minneapolis worry about their futures if the health care legislation remains stalled…”

• Medicaid, while caring for more, faces big budget challenge, By Deborah Yetter, February 9, 2010, Louisville Courier-Journal: “During his 20 years as an electrician, Eric Sachse never sought any type of public assistance. But then Sachse, a 38-year-old single father in Louisville, lost his job - and health insurance for him and his son, 9. So last month, Sachse signed son John up for the Kentucky Children’s Health Insurance Program, a Medicaid program that covers children of low-income parents. Although Sachse doesn’t qualify for Medicaid himself, he said getting coverage for his son is what counts. ‘I was just really fearful of how I was going to take care of any health care situation,’ he said. As the economy has worsened in the past two years, Kentucky’s Medicaid rolls are rising faster than at any other time in the past decade, adding poor, disabled and low-income people at the rate of 3,400 a month…”
• Hawaii may delay payments to Quest health plan, By Derrick DePledge, February 7, 2010, Honolulu Advertiser: “The state Department of Human Services has warned health insurance companies that the state may not make payments for Quest - the state’s health plan for low-income families - for the last quarter of the fiscal year, leaving insurers to absorb about $300 million in medical expenses until at least July. The potential delay in payments has stunned insurers and alarmed health care providers, who worry a delay could jeopardize the ability of insurers to cover claims, which would cause cash flow problems and influence how some providers care for Quest members…”
• Tennessee hospitals push for tax to offset cuts to TennCare, By Chas Sisk, February 9, 2010, The Tennessean: “The Tennessee Hospital Association’s members will push for a temporary tax on their revenues to reduce cuts to the TennCare program proposed last week by Gov. Phil Bredesen. The association’s board voted Monday to approve a one-year ‘coverage fee’ of 1 percent to 2 percent that would raise money for hospital services scheduled to receive less funding from TennCare. The fee likely would go into effect July 1 and would not be passed along to patients, association officials said. The group also will lobby the state to dip further into reserves and to use any additional revenue that comes into the state to reduce TennCare cuts…”
• Medicaid cuts ‘devastating’ to rural hospitals, By Heather Stanek, February 8, 2010, Fond du Lac Reporter: “Rural hospitals around Fond du Lac say a proposed assessment will help them avoid cutting services or raising prices. Ripon Medical Center and Waupun Memorial Hospital are two of the 59 critical-access hospitals across the state dealing with cuts in Medicaid payments. In an effort to slash costs, the state reduced its Medicaid reimbursements by 10 percent, leaving hospitals to pick up heftier bills for caring for low-income patients. Waupun Memorial, part of Agnesian HealthCare, stands to lose $300,000 annually due to Medicaid cuts, said DeAnn Thurmer, WMH chief operating officer. About 10 percent of the hospital’s patients depend on Medicaid. The Wisconsin Hospital Association and Rural Wisconsin Hospital Cooperative are drafting a legislative bill that would help restore federal dollars to rural hospitals…”