Moving the Hahnemann money to Einstein, Jefferson, and Temple -- the shift sought by
It is anything but.
Still, very few, including professionals that closely watch the
The labyrinthine funding system pits hospitals across
"It's a ridiculous way to do things, but that's politics and it's politics in
Hospitals with relatively few Medicaid patients typically depend on commercial health insurance, paid largely by employers, to subsidize the cost of treating poor patients. Because of their locations in
"The bottom line is that Temple and Einstein both are only able to survive because they've been able to wrangle additional dollars from the state and then draw additional matching money" from the federal government, said
But it's not just Einstein and Temple at risk. In the year ended
Penn said it provides "nearly a third of all inpatient care for adult Medicaid patients and over 40 percent of all births covered by Medicaid in the city."
Medicaid's system of subsidies for what are called disproportionate share hospitals started in 1981. It is abbreviated as DSH and pronounced as "dish." Under the Affordable Care Act, Medicaid DSH payments were scheduled to start going down in 2014, but
"When the DSH system was first created, its purpose was to provide extra dollars for specific urban hospitals with high uninsured and very high Medicaid and rural hospitals who needed the extra support just to keep the doors open," Shapiro said. "Over time, the
As of now, virtually any hospital is eligible for DSH payments, subject to statewide limits on the aggregate amounts set by the federal government. In
That report was part of a national discussion of whether "to narrow the subset of hospitals that are able to access these funds and create a higher standard where they really need to be very clear that they are serving people who are low income, people who are still uninsured," said
The largest program for one hospital by far is for
That maneuver generated
In addition to Temple, Jeanes, and Wills, Einstein,
Emblematic of the complicated nature of Medicaid subsidies are the different amounts used to describe Hahnemann's subsidies last year. The senators used
The biggest difference is that
Despite the obscurity of the funding mechanism, the money is critical for
In their letter, the senators said they feared dire consequences if the Hahnemann money is not kept in the city.
"Without concerted action and support of the Commonwealth, we are concerned the failure of Hahnemann could set in motion a cascading series of issues that ultimately could jeopardize the remaining health care institutions serving this community," said the senators' letter, sent from Tartaglione's office and signed by 12 more senators.
The loss of the Hahnemann money is particularly troubling to the senators because it follows the 2016 closure of
In response to questions from The Inquirer, Einstein, Jefferson, and Penn issued statements saying the Hahnemann money should follow the patients.
Wolf's response to the senatorsdetailed restraints that make it impossible to redirect the Hahnemann money to the senators' picks -- even though, subject to federal approval, the state could create new, specifically targeted programs that would benefit Einstein, Temple, and Jefferson.
Representatives for Wolf and Tartaglione did not respond to requests for comment.
That would end "these machinations of fighting for funding," she said. "Instead of all these regulatory and supplemental payments, they pull it right out of their budgets."
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