2013 Legislature: Unknowns ahead for hospitals in health reform law

A big unknown for Nevada hospitals under the federal health care reform law is compensation for costs incurred for treating indigent patients, a legislative panel was told Wednesday.Hospitals currently receive money under the Medicaid program to help cover such costs. But Health and Human Services Director Mike Willden told the Assembly Health and Human Services Committee that those funds may be decreased. Under the Affordable Care Act, the national pool of available funds for the Disproportionate Share Hospital Program will be cut over time, Willden said. That program provides payments to hospitals that provide care to a large share of uninsured or poor people.Nevada's share of disproportionate funding is expected to be cut in half, from around $47 million received in 2012 to $24 million by 2019.“The theory is that more and more people will be insured, there will be less uncompensated costs,” Willden said.After the committee hearing, Willden said the state uses payments from counties to leverage matching federal dollars used to shore up disproportionate payments. Payment contracts with counties have not been finalized and could throw a wrench into the Medicaid budget.He said it's too soon to say what the final outcome will be, but in terms of disproportionate payments he believes “some hospitals will be winners; some hospitals will be losers.”Hospital reimbursements were a small part of an overall discussion Wednesday on the health care law and the Medicaid expansion it includes. Gov. Brian Sandoval has agreed to expand Medicaid eligibility as part of his proposed budget for the next two fiscal years.Willden said Nevada's Medicaid rolls are expected to swell from 319,000 to about 490,000 by 2015.Implementing the plan will not require a massive bill. Willden said there are 35 provisions to incorporate various aspects of the law in Nevada. Those will be included as part of the budget process and will go before legislative money committees.