Photo caption: Teresita Batayola, CEO of International Community Health Services (ICHS) and Ron Chew, ICHS Foundation’s executive director, expect good changes when Medicaid expansion goes into effect.
On the eve of what appears to be Washington state Senate’s adoption of Medicaid expansion in the Affordable Care Act (ACA), a state budget proposal booking Medicaid expansion funds is expected to be released in early April by a Republican majority.
How many people would become eligible for Medicaid under the expansion, and how many would enroll? Seattle-based community health providers like International Community Health Services (ICHS) fully expect the expansion of eligibility for coverage will be quite significant.
Overall, the expansion is good news for providers who take Medicaid and will decrease the numbers of uninsured, said Teresita Batayola, chief executive officer at ICHS.
“Last year, 30 percent of our clients were uninsured,” she reported.
Actual enrollment for coverage will be substantially less than the number of newly eligible for coverage, since not all eligible clients will enroll. According to a recent report from The Urban Institute, the eligibility expansion will add about one million people under the age of 65 — nearly as many as the 1.1 million enrolled in 2011. Slightly more than half of these potential new enrollees — about 545,000 people — are already eligible for Medicaid but not enrolled, and an additional 495,000 people will become newly eligible under the expansion.
Medicaid expansion means that people will get coverage of 138 percent of the federal poverty level, which is very helpful for our population,” she added
“The problem is that not all of ICHS’s current [Asian and Pacific Islander] clients will get coverage. People who have been here legally for five years will benefit. The Medicaid expansion doesn’t cover those who are here legally for less than five years and undocumented immigrants.”
About 10.6 percent of the uninsured are undocumented immigrants, and hence ineligible for Medicaid. This is four times the rate of privately insured people.
Nearly half of currently uninsured Washington residents have incomes below 138 percent of the federal poverty level — the Affordable Care Act’s Medicaid eligibility threshold.
ICHS is one health-care provider that doesn’t ask their clients what their immigration status is, “so our expectation is that our volume of uninsured wi ll be lower,” said Batayola.
Health administrators and professionals like Batayola agree that expanding Medicaid as part of the new Affordable Care Act is leading to a fundamental overhaul of the health-care delivery system in the U.S.
In addition to the expansion of insurance coverage, health-care delivery and payment systems are being revamped. While organizations like ICHS already have partnerships with other hospitals and health-care providers who share electronic medical records, many providers do not have such collaborative arrangements.
Health policy experts like Susan Allan, a professor of public health at the University of Washington, expect that the Medicaid expansion will save the state money, since the federal government will pick up the tab on new enrollees.
The largest group likely to be affected are low-income adults not currently eligible for Medicaid because they are not part of families with eligible children, she added. For the first time, those low-income adults will now be covered.
Some Republicans have expressed concern that the federal government might not live up to its commitment in the long run, leaving states footing the bill years down the road.
The more complex challenge faced by ICHS and other Asian and Pacific Islander (API)-serving health providers is payment reform.
“Currently, health providers are paid according to specific procedures, but the government wants to move nationally towards an evidence-based system,” said Batayola, adding that the federal government has begun pilot programs to investigate this system’s near-term feasibility.
For clients with persistent and multiple adverse health conditions, current payment procedures might not be as good, she explained.
“Paying for every procedure regardless of health improvement is expensive, especially if [patients] go to the emergency room and the hospital for preventable visits,” said Batayola. “Governments are now looking at quality and evidence-based practices that improve health for reimbursements.”
Overall, Batayola said that Medicaid expansion will be a net boon to families and individuals.
“The current Medicaid program focuses on pregnant mothers and children,” she said. “Now, single males and females will benefit from the expansion.”
The Asian Pacific Islander Coalition, the statewide advocacy arm of Washington API social and health services providers, met last month with Gov. Jay Inslee to discuss the ramifications of Medicaid expansion for API individuals and families. The organization represents API communities statewide, including in King, Pierce and Snohomish counties, as well as Spokane, Bellingham and Vancouver.