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Contrary To Popular Belief Medicaid Hospital Admissions Are Often Profitable Because Of Additional Medicare Payments

Author: Jeffrey Stensland, Zachary R. Gaumer, Mark E. Miller
$15.00

It is generally believed that most hospitals lose money on Medicaid admissions. The data suggest otherwise. Medicaid admissions are often profitable for hospitals because of payments from both the Medicaid program and the Medicare program, including payments for uncompensated care and from the Medicare disproportionate-share hospital program. On average, adding a single Medicaid patient day in fiscal year 2017 will increase most hospitals’ Medicare payments by more than $300. When added to Medicaid payments, these payments often cause Medicaid patients to be profitable for hospitals. In contrast, adding a single charity care day in the same year will decrease overall Medicare payments by about $20 on average. The Centers for Medicare and Medicaid Services recently announced a proposal to shift some Medicare payments from supporting hospitals’ costs for Medicaid patients to directly supporting their costs for uncompensated care. If that proposal is adopted, hospitals’ profits on Medicaid patients would decrease, but their losses on care for the uninsured would be reduced.

It is generally believed that most hospitals lose money on Medicaid admissions. The data suggest otherwise. Medicaid admissions are often profitable for hospitals because of payments from both the Medicaid program and the Medicare program, including payments for uncompensated care and from the Medicare disproportionate-share hospital program. On average, adding a single Medicaid patient day in fiscal year 2017 will increase most hospitals’ Medicare payments by more than $300. When added to Medicaid payments, these payments often cause Medicaid patients to be profitable for hospitals. In contrast, adding a single charity care day in the same year will decrease overall Medicare payments by about $20 on average. The Centers for Medicare and Medicaid Services recently announced a proposal to shift some Medicare payments from supporting hospitals’ costs for Medicaid patients to directly supporting their costs for uncompensated care. If that proposal is adopted, hospitals’ profits on Medicaid patients would decrease, but their losses on care for the uninsured would be reduced.

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