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August 3, 2016

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.

Arizona

  • SNCP Waiver Documents 
  • Independent Report: Arizona Health Care Cost Containment System, PCG, August 2014

California

  • Global Payment Program Waiver Documents
  • Independent Report: Evaluation of Uncompensated Care Financing for California Designated Public Hospitals, Navigant, May 2016

Florida

  • Low Income Pool Waiver Documents
  • Independent Report: Study of Hospital Funding and Payment Methodologies for Florida Medicaid, Navigant, February 2015

Hawaii

Kansas

Massachusetts

New Mexico

Tennessee

  • UC Pool Waiver Documents 
  • Independent Report: PCG Review of Medicaid and Uncompensated Care Costs and Supplemental Payment Methodologies in TennCare, PCG, March 2016

Texas

  • UC Pool Waiver Documents
  • Independent Report: Evaluation of Uncompensated Care and Medicaid Payments in Texas Hospitals and the Role of Texas’ Uncompensated Care Pool, HMA, August 2016

*Last updated October 2016