- NEW: Navigating the Health Insurance Marketplace: Community Health Centers and Consumer Assistance Programs, State Policy Report #43
- NEW: 2012 Update on Implementation of the FQHC Prospective Payment System (PPS) in the States, State Policy Report #44
- NEW: Status of PPS Implementation in the Children's Health Insurance Program, State Policy Report #42
- NEW: Florida's Low Income Pool Program, Promising Practices Issue Brief #11
- NEW: Medicaid Reimbursement for Multiple Same-Day Encounters: Florida's Experience, Emerging Issues Issue Brief #7
- FQHC-Specific Language in Medicaid 1115 Waivers, State Policy Report 41
- Defining an Effective Change in Scope Process, Emerging Issues #6
- Update on the Status of the FQHC Medicaid Prospective Payment System in the States - State Policy Report #40
- Calculating the Cost: State Budgets and Community Health Centers, State Policy Report #39
- Emerging Issues in the FQHC Prospective Payment System, State Policy Report #38
State Policy Issues Impacting Health Centers
Health Care Reform - States play a complex and important role when it comes to implementing the major provisions of the Affordable Care Act. For many states, this also means integrating new requirements with new and previous health reform efforts. The expansion of Medicaid and establishment of new health insurance exchanges are just two of the major policy and operational issues states are grappling with that will have a direct impact on health centers and their patients.
Funding for Health Centers - State support to supplement federal investments in health centers is critical for their continued growth and success. State funding to health centers has been on the decline since SFY2008 and is expected to decline further in SFY2013 as the vast majority of states continue to face significant budget shortfalls. 35 states provided $335 million in state funds in SFY2012, representing a 7 year low. Funding is used to pay for uncompensated care, primary and preventative health care services, capital projects, health information technology, loan repayment programs and outreach and education initiatives.
Medicaid - The joint Federal/State program accounts for approximately 39% of health center revenue and covers over 38% of health center patients. Those numbers are expected to significantly increase after 2014 with the Affordable Care Act's sizable expansion of Medicaid to 133% FPL. States have great flexibility in how they can structure their programs including eligibility and benefit design making state administration of Medicaid an increasingly important focal point.
Children's Health Insurance Program (CHIP) - The reauthorization of CHIP in 2009 provides coverage for up to 11 million children, many of whom rely on health centers for their health care needs. Like Medicaid, CHIP is administered by the states and determination of eligibility levels and benefit design are left to state policy makers within federal guidelines.
Health Center Reimbursement - Health centers are reimbursed by Medicaid and CHIP based on a Prospective Payment System (PPS). Beginning in 2014, health plans operating in state-based insurance exchanges will be required to pay health centers no less than the PPS rates paid by Medicaid. As states increasingly move to reform how providers are paid in Medicaid, ensuring fair payment using PPS as the baseline for FQHC services is paramount.
Outreach and Enrollment - Health Centers help a significant number of individuals gain access to health coverage daily through outreach and enrollment activities. With the passage of the Affordable Care Act outreach and enrollment will be vital to help the millions projected to gain access through Medicaid, CHIP and Health Insurance Exchanges. Activities that are innovative and strategic will identify, educate and enroll those who are eligible in a way that is both timely and efficient.
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