As the United States wrestles with the devastating coronavirus, and as Missourians’ expectations of their hospitals continue to increase, I find it ironic that MO HealthNet is proposing major cuts in Medicaid reimbursement of approximately $340 million annually to Missouri hospitals. This includes major revisions in Medicaid outpatient payments as well as the elimination of Medicaid payments to Missouri hospitals for treating out-of-state enrollees, even though they are mandated to do so.

Amidst all the state government’s conversation about promoting and enhancing rural health care, MO HealthNet continues to neuter the Missouri Medicaid program with additional reimbursement cuts and by refusing to pay millions of dollars to Missouri hospitals for overdue Medicaid Rural Health Clinic Cost Report settlements as far back as fiscal year 2014. This nonpayment is creating cashflow issues for many Missouri hospitals that have provided services over the past five years.

This disheartening phenomenon is occurring regardless of the reality that Missouri taxpayers are forced to pay three private managed care companies an aggregate of approximately $170 million per month for Medicaid enrollees they simply administer. Rest assured these companies are paid on time, but they are proficient at denying and rationing medical services and/or stalling payment to the health care professionals who actually provide the patient care.

They are not the ones investing millions of dollars in life-saving CT scanners, MRI units and critical lab, therapy and rehabilitation equipment. Yet, Missouri hospitals are expected to survive on reimbursement of just pennies on the dollar. Many carry a charitable, not-for-profit designation.

This cashflow problem is greatly exacerbated for hospitals by the fact that health care is the only industry in the United States still suffering from sequestration. This 2% reduction has been imposed by the federal government on Medicare reimbursement until 2025.

With regard to the Missouri Medicaid situation, there are three important questions that need to be considered in Jefferson City and by the public.

They are: 1) Has anyone audited these managed care Medicaid companies to see if they are performing according to contract? 2) Have there truly been any cost savings realized by the state because of these added for-profit middlemen? 3) Are Missouri Medicaid enrollees medically benefiting from this complicated process and additional red tape?

If officials in Jefferson City want to see more hospital closings and further decline in Missouri’s rural health services they will continue down this path. I for one do not agree and am advocating for preserving our health care delivery system.

It’s a sad day when our state government is more concerned about paying private, for-profit managed care companies than taking care of the medical backbone of our health care system and communities.

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