Yves here. Wellie, this Administration and Congress are nothing if not consistent. It’s not hard to have made sure to include Medicaid-funded facilities in coronavirus-related rescue programs, particularly given that workplaces heavy with lower-income “essential” workers like meatpacking plants have become disease clusters, endangering their communities. But thanks to this negligence, it appears large swathes of health infrastructure serving the poor will collapse.
By Julie Rovner, Chief Washington Correspondent for Kaiser Health News. Previously, she was the health policy correspondent for NPR and also reported on health policy for National Journal’s Congress Daily and Congressional Quarterly. She is also the author of the critically praised reference book Health Care Politics and Policy A-Z, now in its third edition. Originally published at Kaiser Health News
Casa de Salud, a nonprofit clinic in Albuquerque, New Mexico, provides primary medical care, opioid addiction services and non-Western therapies, including acupuncture and reiki, to a largely low-income population.
And, like so many other health care providers that serve as a safety net, its revenue — and its future — are threatened by the COVID-19 epidemic.
Casa de Salud clinicians, staff and health apprentices stand outside their clinic, socially distanced. (Courtesy of Elizabeth Boyce/Casa de Salud)
“I’ve been working for the past six weeks to figure out how to keep the doors open,” said the clinic’s executive director, Dr. Anjali Taneja. “We’ve seen probably an 80% drop in patient care, which has completely impacted our bottom line.”
In March, Congress authorized $100 billion for health care providers, both to compensate them for the extra costs associated with caring for patients with COVID-19 and for the revenue that’s not coming in from regular care. They have been required to stop providing most nonemergency services, and many patients are afraid to visit health care facilities.
But more than half that money has been allocated by the Department of Health and Human Services, and the majority of it so far has gone to hospitals, doctors and other facilities that serve Medicare patients. Officials said at the time that was an efficient way to get the money beginning to move to many providers. That, however, leaves out a large swath of the health system infrastructure that serves the low-income Medicaid population and children. Casa de Salud, for example, accepts Medicaid but not Medicare.
State Medicaid directors say that without immediate funding, many of the health facilities that serve Medicaid patients could close permanently. More than a month ago, bipartisan Medicaid chiefs wrote the federal governmentasking for immediate authority to make “retainer” payments — not related to specific care for patients — to keep their health providers in business.
“If we wait, core components of the Medicaid delivery system could fail during, or soon after, this pandemic,” wrote the National Association of Medicaid Directors.
So far, the Trump administration has not responded, although in early April it said it was “working rapidly on additional targeted distributions” for other providers, including those who predominately serve Medicaid patients.
In an email, the Centers for Medicare & Medicaid Services said officials there will “continue to work with states as they seek to ensure continued access to care for Medicaid beneficiaries through and beyond the public health emergency.”
CMS noted that states have several ways of boosting payments for Medicaid providers, but did not directly answer the question about the retainer payments that states are seeking the authority to make. Nor did it say when the funds would start to flow to Medicaid providers who do not also get funding from Medicare.
The delay is frustrating Medicaid advocates.
“This needs to be addressed urgently,” said Joan Alker, executive director of Georgetown University’s Center for Children and Families in Washington, D.C. “We are concerned about the infrastructure and how quickly it could evaporate.”
In the administration’s explanation of how it is distributing the relief funds, Medicaid providers are included in a catchall category at the very bottom of the list, under the heading “additional allocations.”
“To not see anything substantive coming from the federal level just adds insult to injury,” said Todd Goodwin.
He runs the John F. Murphy Homes in Auburn, Maine, which provides residential and day services to hundreds of children and adults with developmental and intellectual disabilities. He said his organization — which has already furloughed almost 300 workers and spent more than $200,000 on COVID-related expenses including purchases of essential equipment such as masks and protective equipment that will not be reimbursable — has not been eligible for any of the various aid programs passed by Congress. It gets most of its funding from Medicaid and public school systems.
The organization has tapped a line of credit to stay afloat. “But if we’re not here providing these services, there’s no Plan B,” he said.
Even providers who largely serve privately insured patients are facing financial distress. Dr. Sandy Chung is CEO of Trusted Doctors, which has about 50 physicians in 13 offices in the Northern Virginia suburbs around Washington, D.C. She said about 15% of its funding comes from Medicaid, but the drop off in private and Medicaid patients has left the group “really struggling.”
“We’ve had to furlough staff, had to curtail hours, and we may have to close some locations,” she said.
Of special concern are children because Medicaid covers nearly 40% of them across the county. Chung, who also heads the Virginia chapter of the American Academy of Pediatrics, said that vaccination rates are off 30% for infants and 75% for adolescents, putting them and others at risk for preventable illnesses.
The biggest rub, she added, is that with the economy in free fall, more people will qualify for Medicaid coverage in the coming weeks and months.
“But if you don’t have providers around anymore, then you will have a significant mismatch,” she said.
Back in Albuquerque, Taneja is working to find whatever sources of funding she can to keep the clinic open. She secured a federal loan to help cover her payroll for a couple of months, but worries what will happen after that. “It would kill me if we’ve survived 15 years in this health care system, just to not make it through COVID,” she said.
KHN senior correspondent Phil Galewitz contributed to this story.
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Really, if the workers labeled as essential were really considered so, this would not be happening. They can always bring in the prison slaves from the largest prison population on Earth to do the work and more cheaply too. So, go die?
Medicaid has long been on the block-grant death list.
Everything’s going according to plan.
A systemic gutting of the wretched healthcare safety net will be seen by patients in micro–the closing of their local clinic–so they will wander off when they see the closing sign at the local poors clinic.
Random public service announcements will instruct them to buy “accessible” ACA insurance plan premiums. Government subsidized premiums will be deposited directly into the coffers of insurance corps with actual-care™ deductibles and co-pays the poors can’t afford anyway.
Their fault if they didn’t choose right, innit?
Soon back alley appendectomies will join back-alley abortions as the new normal for the uninsured, undeserving, dispossessed labor pool too busy battling evictions, mortgage defaults and starvation to get noticed.
Problem F*cking solved.
Few things in this country’s history have demonstrated the need for a national healthcare program like the Covid19 has. We see the hap hazard method of providing health care to the people that call themselves “citizens”. I use that reference because left up to one political party, the rest can pound salt. See, if you’ve got it, well then you’re O.K. If not, you fall into the category of “goes to work each morning, works hard, receives minimum pay for the work BUT , job has healthcare, so he’s got to keep it, even if it means exposing himself to REAL danger. Nope, I think it’s time we took a long hard look at how we stay healthy in this country and make some serious changes to the current system. Bernie WAS right about a few things.
Just give the medicaid centers some F-35s and other weapons systems — to keep the arms manufacturers happy — and they can be sold at discounts to various countries to finance the medical centers. What could go wrong?
Yes, it is true that some health workers have been laid off. It is not only Medicaid or federally qualified health centers that have had to cut back services. Also floundering are the home health aide services, dialysis services, the hospice services – not to mention the long-term and nursing home facilities. There are so many aspects to this emergency and the responses continue to breed inequitable results.
Uwe Reinhardt used to say that politicians were too “shy” to openly discuss the health inequities their policies leave. He was joking of course. Shyness is not really the cause.
The most populous county here in Southwest Florida, Lee county, has basically one hospital system which is the largest employer in the county. Yesterday they announced that they were offering almost all employees a “generous” severance package or a four to six week sabbatical this summer. Admissions for elective surgeries are down at least fifty percent. As difficult as it has been to get a job with health insurance over the last few years it seems difficult to believe that in the next few years jobs with health insurance will be any easier to come by.