Restoring fiscal integrity to medicaid financing?

Health Affairs

Volumn 26, Issue 5, 2007, Pages 1469-1480

  Coughlin, Teresa A ^a   Zuckerman, Stephen ^a   McFeeters, Joshua ^a  

^a URBAN INSTITUTE   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; ECONOMICS; FEE; GOVERNMENT; HEALTH CARE PLANNING; HUMAN; LEGAL ASPECT; MEDICAID; POVERTY; REIMBURSEMENT; SOCIOECONOMICS; UNITED STATES;

CENTERS FOR MEDICARE AND MEDICAID SERVICES (U.S.); HUMANS; MEDICAID; MEDICAL INDIGENCY; POVERTY; RATE SETTING AND REVIEW; REIMBURSEMENT, DISPROPORTIONATE SHARE; STATE HEALTH PLANS; UNITED STATES;

EID: 35148876968     PISSN: 02782715     EISSN: 02782715     Source Type: Journal    
DOI: 10.1377/hlthaff.26.5.1469     Document Type: Article

References (36)

1. See, for example, U.S. Government Accountability Office, Medicaid: State of Illusory Approaches to Shift Program Costs to Federal Government, Pub. no. GAO/HEHS-94-133 (Washington: GAO, August 1994);
2. GAO, Medicaid: State Financing Schemes Again Drive Up Federal Payments, Pub. no. GAO/T-HEHS-00-193 (Washington: GAO, September 2000);
3. U.S. Department of Health and Human Services Office of Inspector General, "Review of Illinois' Use of Intergovernmental Transfers to Finance Enhanced Medicaid Payments to Cook County for Hospital Services," March 2001, http://oig.hhs.gov/oas/reports/region5/50000056.pdf (accessed 22 June 2007);
4. OIG, "Review of Medicaid Enhanced Payments to Public Providers and the Use of Intergovernmental Transfers by the Alabama State Medicaid Agency," March 2001, http://oig.hhs.gov/oas/reports/region4/40002165.pdf (accessed 22 June 2007);
5. and T.A. Coughlin and S. Zuckerman, "States' Use of Medicaid Maximization Strategies to Tap Federal Revenues: Program Implications and Consequences," in Federalism and Health Policy, ed. J. Holahan, A. Weil, and J.M. Weiner (Washington: Urban Institute Press, 2003).
6. See, for example, L.S. Gage, "Statement of National Association of Public Hospitals to Congress Staff, DHHS Proposed Rule on Medicaid Upper Payment Limits" (Washington: National Association of Public Hospitals, 11 December 2001); and Barbara C. Edwards, Ohio Medicaid director, Testimony before the Senate Finance Committee 28 June 2005.
7. See, for example, Thomas Scully, administrator, CMS, "Challenges Facing the Medicaid Program in the Twenty-first Century," Testimony before the House Energy and Commerce Subcommittee on Health, 8 October 2003;
8. and S. Schwartz et al., "Moving beyond the Tug of War: Improving Medicaid Fiscal Integrity" (Washington: National Academy for State Health Policy, August 2006).
9. Federal Register 67, no. 13 ( 18 January 2002): 2602-2611.
10. T.A. Coughlin, B. Bruen, and J. King, "States' Use of Medicaid UPL and DSH Financing Mechanisms," Health Affairs 23, no. 2 (2004): 245-257.
11. See, for example, T.A. Coughlin, L. Ku, and J. Kim, "Reforming the Medicaid Disproportionate Share Program in the 1990s," Health Care Financing Review 22, no. 2 (2000): 137-157.
12. Urban Institute analysis of CMS-64 data and data from the 2005 Current Population Survey.
13. Coughlin et al., "Reforming the Medicaid Disproportionate Share Program";
14. L. Ku, "Limiting Abuses of Medicaid Financing: HCFA's Plan to Regulate the Medicaid Upper Payment Limit" (Washington: Center on Budget and Policy Priorities, September 2000);
15. and GAO, Medicaid: State Financing Schemes.
16. The one important exception to the Medicare UPL rule is Medicaid DSH payments, which can exceed the UPL but for which hospital- and state-specific spending is instead imposed.
17. Coughlin et al., "Reforming the Medicaid Disproportionate Share Program"; Ku, "Limiting Abuses of Medicaid Financing";
18. GAO, Medicaid: State Financing Schemes;
19. GAO, Medicaid: HCFA Reversed Its Position and Approved Additional State Financing Schemes, Pub. no. GAO-02-147 (Washington: GAO, October 2001);
20. and M.F. Mangano, "Review of Medicaid Enhanced Payments to Local Public Providers and the Use of Intergovernmental Transfers" (Memo from principal deputy directory of OIG to Tom Scully, 11 September 2001).
21. Federal Register 66, no. 9 (12 January 2001): 3154.
22. The excessive payment phase-outwas included in P.L. 100-203, and DSH hospital reporting provisions, in P.L. 108-173. The estimate of UPL transition amounts is from the CMS National Institution Reimbursement Team, 17 December 2004.
23. States responding in 2005 for which we could not analyze changes between 2001 and 2005 were AR, CO, DE, ME, NV, NM, PA, RI, and TN. The twenty-five states that responded in 2001 and 2005 were CA, DC, FL, GA, HI, ID, IA, KS, LA, MD, MA, MI, MO, NE, NJ, ND, OK, OR, SC, TX, UT, VT, VA, WA, and WY.
24. Urban Institute analysis of 2005 CMS-64 data.
25. Ibid.
26. L. Ku and T.A. Coughlin, "Medicaid Disproportionate Share and Other Special Financing Programs," Health Care Financing Review 16, no. 4 (1995): 27-44;
27. Coughlin et al., "Reforming the Medicaid Disproportionate Share Program"; and Coughlin et al., "States' Use of Medicaid UPL."
28. Unfortunately, the survey did not allow us to determine with certainty whether any similar payback occurred with DSH payments.
29. P. Harbage and A. Schneider, "Medicaid Hospital Waivers: Comparing California, Florida, and Massachusetts" (Oakland: California HealthCare Foundation, April 2006).
30. Coughlin and Zuckerman, "States' Use of Medicaid Maximization Strategies."
31. Including residual funds that states collected in the state share would inappropriately lower our estimate of the federal share of SPs. For this analysis, we removed residual funds from the category of state spending from which they were derived before computing the federal share of SPs. When it was not clear which source of state funds (IGTs, CPEs, state transfers, or general funds) the residual funding came from, we lowered funding fromeach category in proportion to that category's share of state funding for DSH and SP.
32. These numbers are illustrative and are not precise estimates of the federal share for payments made through SP programs.
33. Urban Institute analysis of 2005 CMS-64 data.
34. D.G. Smith, director, Center for Medicaid and State Operations, CMS, "Intergovernmental Transfers: Violations of the Federal-State Medicaid Partnership or Legitimate State Budget Tool?," Testimony before the House Energy and Commerce Committee, 1 April 2004.
35. Schwartz et al., "Moving beyond the Tug of War."
36. OIG, "Audit of Selected States' Medicaid Disproportionate Share Hospital Programs," Pub. no. A-06-03-0031 (Washington: OIG, March 2006).