Washington, DC—Medicaid documentation requirements enacted by Congress in 2006 are already having a major and measurable impact on health centers and their patients, according to a new analysis issued by The George Washington University School of Public Health and Health Services (GW/SPHHS).  These new requirements—affecting both children and adults nationally–are disrupting coverage for thousands of Medicaid-enrolled health center patients, while delaying applications and enrollment for thousands more. Health center capacity to care for both insured and uninsured patients is being affected.

In 2005, health centers—the largest source of comprehensive primary care for low income patients—cared for more than 14 million persons, including more than 5 million Medicaid beneficiaries and 5.2 million low-income children. Medicaid accounts for 37 percent of all health center operating revenues.  Results from this initial national impact assessment show that:

  • Documentation requirements have caused a nationwide disruption in Medicaid coverage for health center patients, with more than 90 percent of all health centers reporting enrollment difficulties for patients of all ages, including newborn children.
  • More than 43 percent of health centers report that patients are experiencing one or more of the following problems: a longer enrollment process, a longer application process, the lack of appropriate documentation or having to pay to get necessary documents.
  • One third of health centers report having to increase staff time for patient enrollment assistance.
  • Enrollment delays and disruptions have affected the ability of almost half (45 percent) of reporting health centers to arrange for specialty care; 38 percent report difficulties in securing healthcare access for new patients; 28 percent report difficulties in pre-arranging hospital inpatient deliveries for pregnant women, and 24 percent report difficulties in securing supplies and equipment.

The immediate estimated impact of these new documentation requirements is elimination of Medicaid coverage for some period of time for between 2.2 and 6.7 percent of all Medicaid enrolled patients. This estimate is extremely conservative and does not take into account impact on newborn children or new applicants. Between 105,100 and 319,500 Medicaid patients, including up to 212,400 children and 107,100 adults, are expected to be affected. Patient  impact translates into immediate Medicaid revenue losses of as much as $85 million, representing

  • Services to as many as 166,000 uninsured patients.
  • Staffing reductions of as many as 83 physicians, 66 dental professionals, 18 pharmacists, 33 mental health professionals, or 140 nurses and physician assistants.
  • The loss of up to one percent of all health center operating revenues
  • The loss of the entire operating surplus reported by health centers in 2005, which is crucial in planning for unanticipated emergencies.
  • As many as 131 “new start” health centers in the nation’s poorest counties.

“These initial results underscore that increasing Medicaid enrollment barriers have enormous implications for healthcare access and quality,” said Sara Rosenbaum, JD, Hirsh Professor and chair, SPHHS Health Policy Departemnt and a study co-author.

Julio Bellber, president of the RCHN Community Foundation, which supports the study as well as ongoing health center research and scholarship at GW, said, “The Foundation is committed to supporting research and dissemination of findings related to access, health equity and the role of health centers. This study presents a clear picture of the devastating impact the Medicaid documentation requirements have—and will continue to have—on health centers and their patients.”

Dan Hawkins, vice president for Federal, State and Public Affairs at the National Association of Community Health Centers, said, “The report signals the danger for millions who desperately need—and qualify for—Medicaid coverage, and the imminent harm facing an already beleaguered healthcare safety net.”

The report, “An Assessment of the Effects of Medicaid Documentation Requirements on Health Centers and Their Patients” can be downloaded at: www.gwumc.edu

About the RCHN Community Health Foundation
The RCHN Community Health Foundation (RCHN CHF) is a New York-based not-for-profit operating foundation dedicated to supporting and benefiting community health centers (CHCs) in New York state and nationally.  The Foundation develops and supports programmatic and business initiatives related to community health center access, pharmacy and health information technology through strategic investment, research, outreach, education, and coalition building and advocacy. For more information about RCHN CHF, contact Executive Vice President Feygele Jacobs at (212) 246-1122, ext. 712, or fjacobs@rchnfoundation.org.

About The George Washington University Medical Center
The George Washington University Medical Center is an internationally recognized interdisciplinary academic health center that has consistently provided high-quality medical care in the Washington, DC, metropolitan area for 176 years. The Medical Center comprises the School of Medicine and Health Sciences, the 11th oldest medical school in the country; the School of Public Health and Health Services, the only such school in the nation’s capital; GW Hospital, jointly owned and operated by a partnership between The George Washington University and Universal Health Services, Inc.; and the GW Medical Faculty Associates, an independent faculty practice plan. For more information on GWUMC, visit www.gwumc.edu.

All news releases available online at www.gwumc.edu/mccm.