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Uncompensated Care Pools

A number of state Medicaid programs have received approval under 1115 demonstration authority for funding pools to compensate providers for the uncompensated costs of serving Medicaid and uninsured individuals, in particular to ensure sufficient support for certain providers as the states have moved to managed care.  Eyman Associates is engaged with providers in a number of these states and tracks federal policy developments in this area.

Of particular note, the federal Centers for Medicare and Medicaid Services (CMS) has outlined principles for their review of state uncompensated care pool requests under 1115 demonstration waivers.  Specifically:

  1. Coverage is the best way to assure beneficiary access to health care for low income individuals and uncompensated care pool funding should not pay for costs that would otherwise be covered in a Medicaid expansion;

  2. Medicaid payments should support the provision of services to Medicaid and low income uninsured individuals; and,

  3. Provider payment rates must be sufficient to promote provider participation and access, and should support plans in managing and coordinating care.

Below is a comprehensive resource of existing uncompensated care (UC) pool and related programs, including independent evaluations being required by CMS as part of UC pool approvals or extensions.