Medicaid cuts impact ER visits
Houston County Courier
ETMC Crockett is responding to recent cuts in Medicaid reimbursements that will have a serious impact on hospitals across the state. According to ETMC Crockett Administrator Terry Cutler, effective Sept. 1, Texas’ Medicaid program slashed its reimbursement to hospitals by 40 percent for the treatment of non-emergency and non-urgent services during an emergency room visit. “It is important to remember that these reductions are coming straight from Texas Medicaid and not from ETMC—hospitals across Texas are adapting to this new reimbursement environment. This reduction will be applied to claims that are submitted for Texas Medicaid and Children with Special Health Care Needs (CSHCN) clients,” Cutler said. Medicaid reimbursement to hospitals will not be reduced for treatment of healthcare conditions that have high severity, those that require urgent evaluation by a physician or those that pose an immediate and significant threat to a patient’s physical or mental function. “Reimbursement for diagnostic services, such as laboratory and radiology, will not be reduced by 40 percent,” he added. According to the Texas Medicaid Healthcare Partnership (TMHP), emergency services are defined as “those rendered in a hospital emergency room after the sudden onset of a medical condition that manifests itself by acute symptoms of sufficient severity such that the absence of immediate medical attention could reasonably be expected to result in serious jeopardy to the client’s health, serious impairment to bodily functions or serious dysfunction of any bodily organ or part.” According to the THA, Medicaid enrollment has increased by 78 percent in the 1.9 million to 3.4 million recipients–while the state’s population has grown 20 percent. Medicaid expenditures have risen at a rate of between seven to nine percent per year. The report continues by indicating that federal matching funds for Medicaid have been reduced significantly as the temporary increase in the federal matching assistance percentage from the ARRA (stimulus) comes to an end. The Federal Medical Assistance Percentages (FMAP) was 0.68 in 2009 and it will drop to 0.58 in 2012. This approximate 10-point drop means that the state’s share of Medicaid expenditures will increase by about one-third.