Some states have chosen to expand. Others have not. The questions we often find ourselves asking are what does this mean for health systems, like FQHCs and hospitals, that are required to provide services in both expanded and non-expanded states? And where are these health systems more likely to be reimbursed for services?

PointCare breaks down the data for more than 230,000 uninsured patients who were screened to determine eligibility for coverage and additional benefits over the past 16 months.

Expanded versus Non-Expanded

Before we look at the data, it’s important to understand the difference between these distinctions. Expanded states are states that chose to expand Medicaid as part of the ACA to all adults at or below 138% Federal Poverty Level (FPL). As a result, some previously-covered categories of individuals, such as parents and adults with disabilities, also experienced an increase in income limits in these states. Non-expanded states are states that chose to continue offering Medicaid to the same categories of individuals - typically including parents, pregnant women, children, and the elderly or individuals with disabilities or who are blind and excluding adults who do not have dependents.

Data Set

In the past 16 months, PointCare users at more than 500 health centers and hospital facilities in 26 states used PointCare’s qualification software to actively screen uninsured patients for coverage and additional benefits every month. These users performed 238,927 qualifications in 16 expanded states and 10 non-expanded states. PointCare has analyzed the results of these qualifications to try to help answer the questions posed above: What does expansion or non-expansion mean for health systems, like FQHCs and hospitals, that are required to provide services in both expanded and non-expanded states? And where are these health systems more likely to be reimbursed for services?

Expanded States

In 16 of the 33 expanded states, PointCare users conducted 192,286 qualifications. 81% or 155,751 of these patients qualified for full Medicaid and/or subsets of Medicaid in their state. Of the patients that qualified for Medicaid, 69% also qualified for additional benefits, such as the Supplemental Nutrition Assistance Program (SNAP), Women-Infants-Children (WIC), and financial or premium assistance. For those that did not qualify for Medicaid, 67% still qualified for some type of additional benefit.

Non-Expanded States

In 10 of the 17 non-expanded states, PointCare users conducted 46,641 qualifications. 50% or 23,320 of these patients qualified for full Medicaid and/or subsets of Medicaid in their state - a number that is lower than the 81% that qualified in the expanded states, but that is higher than many expected. Of the patients that qualified for Medicaid, a much higher percentage than the expanded states, 96% qualified for additional benefits.  Additionally, 78% of the Medicaid-eligible patients also qualified for some type of additional benefit - again, a percentage this is higher than the expanded state results.

Summary

So what does expansion or non-expansion mean for health systems being able to cover patients and receive reimbursement? It’s no surprise that more patients qualified for Medicaid in expanded states versus non-expanded states. Answering the question that for those health systems in expanded states reimbursement is most likely to come from Medicaid and/or a subset of Medicaid. In non-expanded states, however, more patients who presented for services qualified for Medicaid than expected. This leaves the question:  Do FQHCs and hospitals in both expanded and non-expanded states have their qualification and enrollment process tightened up to consistently and accurately convert these uninsured patients to either Medicaid or an additional benefit program that will provide reimbursement for services rendered?