A new report on Medicaid payment reform and community health centers reviews the key elements of Medicaid's Federally Qualified Health Centers (FQHC) payment rules, describes the flexibility available under federal law that permits states and health centers to develop alternative payment methodologies, and provides an in-depth profile of five states' experience in crafting reforms to Medicaid payments for health centers. Produced with support from the Commonwealth Fund and the RCHN Community Health Foundation, the report was prepared by the Geiger Gibson/RCHN Community Health Foundation Research Collaborative at the Milken Institute School of Public Health (Milken Institute SPH) at the George Washington University (GW).
The analysis looks at five Medicaid expansion states (California, Colorado, Minnesota, New York and Oregon) and finds that health centers and Medicaid agencies in these states are testing payment alternatives, such as global payments, that link payment to health center performance. "These alternative payment approaches enable health centers to test new strategies to address the needs of their patients, while allowing state Medicaid programs to align health center payment strategies more closely with broader payment reform efforts," the authors say. Inclusion of health centers in payment reform is crucial; in 2015, health centers cared for one in five Medicaid beneficiaries nationally.
Peter Shin, Jessica Sharac, and Sara Rosenbaum at Milken Institute SPH Department of Health Policy and Management and Zoe Barber, now at the Office of the National Coordinator for Health Information Technology, authored the new issue brief titled, "Community Health Centers and Medicaid Payment Reform: Emerging Lessons from Medicaid Expansion States."
The Commonwealth Fund has also published a blog that goes along with the report, titled: "Medicaid Payment Reform and Community Health Centers: Is the FQHC Payment System Beginning to Evolve?" It can be found at: http://www.commonwealthfund.org/Publications/Blog/2016/Oct/Community-Health-Centers-Medicaid-Payment-Reform
The blog by Rosenbaum, Shin, and Sharac points out two challenges in health center Medicaid payment reform at health centers: how to balance health centers' role in caring for both insured patients and uninsured patients, who in 2015 represented 24 percent of all health center patients despite the Affordable Care Act expansion; and how to use payment reform to stimulate efficiency and innovation. "Working with health centers, several Medicaid expansion states are now beginning to adapt the federal payment policies that apply to health centers in order to meet these important challenges," the authors say.
Feygele Jacobs, President and CEO of the RCHN Community Foundation, added: "Community health centers are crucial to health transformation, especially for the poor and underserved, and we have much to learn from these early Medicaid reform efforts."
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