North Carolina originally planned to expand Medicaid coverage, but the Supreme Court ruling and the later election of the North Carolina government entirely by Republicans caused North Carolina to withdraw from Medicaid expansion.
Last fall, Republican Gov. McCrory was making statements to the Heritage Foundatiom that North Carolina may have to expand Medicaid to get Federal reimbursement even though we don’t want to.
The reason is another provision of the affordable care act. The law requires that when a person shows up at a hospital and is not insured – the hospital or clinic may do some preliminary screening and then submit bills for the patient to apply for Medicaid under the basis of presumptive coverage. If the patient fails to actually be covered by Medicaid, the state is still required to pay the costs of the treatment for up to two months.
http://www.charlotteobserver.com/2013/10/23/4410230/gov-mccrory-says-north-carolina.html
For example, a woman may claim to be pregnant and therefore be eligible for Medicaid. But she might not be pregnant, she might terminate the pregnancy, she might not be a US citizen, she may just never apply for Medicaid or actually not be eligible – so when that is determined, the Medicaid coverage is revoked, but not the bills.
North Carolina Medicaid (without the expansion) is fairly limited in who can get it. Not only do you have to be poor, you have to be in a category that is eligible for it – pregnant, disabled, blind, families with children and Medicare recipients. Presumptive coverage only applies to pregnant women – but the Feds have said that hospitals apply for other categories of patients, even though North Carolina doesn’t have a law requiring the state to cover them and hasn’t funded it.
Once you find this out, it becomes much clearer why hospita
S want to bill for an entire treatment of a very expensive drug (like TPA to daissolve bold clots causing a stroke) because until Medicaid pulls the plug, the hospital has a blnk check to bill. The only good part is the reimbursement rates are so low, there is not much incentive to farm patients for cash.
You have the “farming” part spot on, Art. This is an expanding practice in the healthcare realm. My friend who is a GastroEnterologist, can expound for hours on how this works and how pervasive it is.
If you thought there were doctors and hospitals going unpaid in the past, imagine with fewer dollars available for the $5000 bill now that the same people need to pay insurance companies first before they have any money for their $5000 deductibles…. and of course, pay higher taxes for all those new IRS agents to enforce.
I have a female friend in California who is a retired state employee. She had an infection and made the mistake of having it looked at. Because they knew she had really “good”insurance, of course she needed intravenous antibiotics administered at the hospital. She was beginning to freak out that the hospital was not going to allow her to leave – she eventually got aggressive enough that she forced them to let her to be discharged, but if she had been a Medicaid patient – you know she never even would have been admitted in the first place.
I’ve heard of cases where the hospital ends up paying the premium for the patient – that way even though the patient can no longer pay the premium, the hospital keeps the revenue stream alive. The premium is just “cost of doing business”. They would Milclay insurance until the lifetime maximum was reached – and then dumped the patient on the street to die. Of course, now that Obama care is ended lifetime caps – the sky is the limit