The first quarter returns after Medicaid expansion are back and, according to a report released by the Colorado Hospital Association (CHA), accountability is on the rise.

As part of the Patient Protection and Affordable Care Act (PPACA), 26 states across the U.S. voluntarily underwent an expansion of Medicaid eligibility on January 1, 2014. That meant allowing more low income patients to receive government funding for medical care. A report from the CHA examines first quarter results on 465 hospitals in 30 states, 15 of which opted for Medicaid expansion and 15 which did not. They found that expansion states experienced a 29 percent increase in Medicaid patients, while also experiencing a 25 percent decrease in patients paying out of pocket, and a 30 percent decrease in charity care, or uncompensated care. As expected, there was no significant change to those percentages for non-expansion states.

When an uninsured patient requires services they cannot afford they receive charity care, which costs hospitals, federal, and local governments tens of billions of dollars a year. The CHA's study suggests that by allowing more would-be charity care cases access to allocated federal support via Medicaid, they are finding ways to take responsibility for their expenses and contribute productively to their health care revenue system. This is significant news for hospitals, which rely on that income to pay workers and provide better services, but are often left to absorb charity care costs.
DOTmed News spoke to Chris Tholen, CHA's Vice President of Financial Policy, about their findings. Tholen explained that determining who ultimately pays for charity care is never cut-and-dried. "Different hospitals are funded differently," says Tholen, "so there's a cost shift between private hospitals and public hospitals." In some cases, there are special services implemented specifically for managing charity care costs, he says.

Concentrating on the future

In 2013, non-expansion states in the report had a marginally smaller percentage of Medicaid patients, (around 13 percent versus 15 percent) and a marginally higher percentage of Medicare patients, (about 41 percent versus 38 percent). The non-expansion states also paid roughly $1 million dollars more quarterly on charity care than expansion states. After Medicaid expansion, that margin increased another million. But Tholen warns against drawing distinctions between the two groups before expansion, "There are many factors, such as size of hospital, which influence those figures. What's important is that those hospitals face the same issues [as expansion hospitals], and the value of the study is in quantifying lost opportunity."

More Industry Headlines