A recent Supreme Court decision could potentially inhibit medical care provided to Medicaid recipients. The Court held that medical providers could not sue states for unfair reimbursement rates for services provided to Medicaid recipients.
Historically Medicaid reimbursement rates have been low compared to that under Medicare or private health insurance. According to the American Hospital Association and the Federation of American Hospitals the cost of providing care to Medicaid beneficiaries in 2012 exceeded reimbursements by $13.7 billion.
After the Supreme Court decision, if a state is not providing fair reimbursement rates the only recourse Medicaid providers have is to report it to the U.S. agency that oversees the joint federal-state program, the Department of Health and Human Services. The only recourse that agency has is to withhold all Medicaid funds from the state, something that has never happened and is not likely to happen now.
Physician willingness to participate in the Medicaid program is largely dependent upon reimbursement rates. Many are concerned that an inability to effectively request fair reimbursement rates may reduce medical care available to an already vulnerable group of individuals.
We will continue to monitor this and other news that affects seniors and persons with disabilities in Indiana. If you have questions about paying for your medical care, we are here to help.