I love the phrase "shifting revenue landscape" to describe the demonstrable effects of Medicaid expansion on hospital admissions and revenue streams. Coined by Modern Healthcare, this is the industry's way of saying that Medicaid expansion is changing acute care hospital balance sheets with more Medicaid admissions and fewer uncompensated care (read: uninsured or underinsured) admissions.
A fair number of earlier anecdotal reports on the trend are now overshadowed by HHS's report on the Impact of Insurance Expansion on Hospital Uncompensated Care Costs in 2014, documenting the trend. The trend, of course, is most prounounced in Medicaid expansion states, as part of the great migration of the low income to expansion Medicaid.
What's happening in those non-Medicaid expansion states? Well, Medicaid hospital admissions are up as well — possibly an after effect of streamlined and de-stigmatized Medicaid enrollment — and uncompensated care delivery is down there as well, but by a much lower amount.
DISH payments will soon begin to contract in both Medicaid expansion and non-expansion states. Faciliities in non-expansion states that have long used DISH to fund the large number of uninsured at their gates, are announcing changed policies for eligibility for uncompensated care.
I imagine that is how Truman Medical Center ended up on the front page of the Kansas City Star on September 18th, after having announced that uncompensated care would no longer serve those with incomes up to 400 percent of the federal poverty level but, rather, assist only those with household incomes up to 200 percent of the federal poverty level.
"The Change was intended to motivate people to sign up for health insurance plans through the Affordable Care Act," the Star notes. But then the article concludes without any direction as to how an individual might seek assistance with an application to purchase health insurance through the federally facilitated exchange or, even, make an application for Medicaid.