Hospital board may rethink Medicaid decision

April 28--WARRENSBURG -- Western Missouri Medical Center trustees may rethink remaining neutral on state Medicaid expansion.

In March, the board reaffirmed last year's decision to table the "partisan political issue."

At Friday's board meeting, the board heard Missouri Hospital Association information showing state hospitals have eliminated almost 1,000 full-time equivalent positions in the last six months and a hiring freeze has been implemented for another 2,145 positions. Much of the reduction has hit the state's rural areas.

Hospitals are delaying or canceling capital projects and cutting services in response to the decreased funding.

The association, which supports Medicaid expansion, said reductions result from "federal funding cuts, high uncompensated care costs and changing utilization patterns."

Without new revenue from expanding health insurance coverage through the health insurance marketplace or Medicaid reform, "hospitals' financial outlook is bleak," and hospitals could lose 5,000 employees by the end of the decade, the association stated.

Hospitals provided nearly $1.2 billion in uncompensated health care services in 2012, and charity care jumped by 32 percent since 2010, based on association information.

Missouri hospitals began seeing reductions in Medicare reimbursement in 2013. Federal reimbursement is expected to be reduced by about $4 billion between 2013 and 2019.

"We may have to rethink our position. If what the details say are true, it's pretty frightening," board member Stephanie Long said.

Board member Steve Higgins said the information should be forwarded to state legislators "and let them take action."

Board President Kit Lindsay asked whether any impact has been noted in states that accepted Medicaid expansion.

CEO Susan Stiles said Affordable Care Act signups ended in March and some states are seeing an increase in patient admissions.

"The self-pay part is not climbing. ... Early on, there's some impact to that," Stiles said.

Lindsay suggested monitoring the situation "to see if there's a flow of money coming in." He said a board decision on Medicaid "has no impact" because the board has no control over Medicaid.

Long said the board's position "may send a message to our local representatives. If they think we don't want it, they won't vote for it."

Stiles said no specific ideas have come from opponents to resolve the Medicaid issue.

"Meanwhile, we're going to be hit," board member Larry Purcell said.

"It's very important to the hospital. I believe we need to have something done. We're losing money. ... We've taken a hit," Stiles said.

She said the hospital "is supposed to get a benefit" from Medicaid expansion.

Without expansion, the hospital is penalized, she said.

"We're hurting even more. We're going downhill," Stiles said.

On top of the loss of additional revenue, she said, the federal government's sequestration affects the hospital.

"Obviously, we hope they find some solution," she said. "Two billion dollars is being lost (in Missouri)."

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