Health Policy Journal 1

IHP 610 Final Project Issue Prompt Option #3: Access and Enrollment Assistance

The Health Law and Policy Issue: Aspen County is in the State of Golden. The State of Golden opted not to participate in Medicaid expansion. Its Medicaid program pays for services on a fee-for-service basis. The three Aspen County Commissioners largely support the decision not to expand Medicaid. In general, voters believe that the less government involvement in their lives, the better. Recent Aspen County polling data indicates that if given an opportunity, voters in Aspen County would like to discontinue all public health services in the county. Healthcare providers in Aspen County report that their payer mixes are shifting. On average, providers in the area (including Aspen County Hospital) have traditionally served 1/3 Medicare patients, 1/3 commercial patients, and the remaining percentage split between Medicaid and uninsured patients. Recently, providers report that they are delivering more uncompensated care and have fewer commercially insured patients. Providers in for-profit settings are particularly concerned about this development. Basalt Primary Care, the largest primary care practice in Aspen County, has decided to terminate its uninsured and Medicaid patients. Basalt Primary Care reports that its doctors can no longer afford to take Medicaid rates or receive no payment for services. Wait times for Basalt Primary Care’s remaining patients average less than one week for the next available appointment. Same-day appointments are occasionally available. Other primary care practices report the following average wait times for next available appointments:

 1–2 weeks for commercially insured patients

 1–2 weeks for patients willing to pay cash up-front for services

 3–5 weeks for Medicare patients

 6–9 weeks for Medicaid patients Wait times are rumored to be shorter at school-based clinics and urgent care clinics throughout Aspen County, but no data is collected about wait times at these facilities. The federal government has made grant funds available for primary care practices and public health departments to hire enrollment assisters for up to two years. The assisters go through training (paid for by the grant funds) to help patients enroll in Medicaid or Medicare, or purchase insurance coverage in a marketplace. The federal government pays salary and benefits for the enrollment assisters. The only out-of-pocket costs to the primary care practices and public health departments are workspace and supplies. The grant funds are available directly from the federal government and are independent of any other healthcare reform funds. You are the director of the Aspen County Public Health Department. The department also serves as a federally qualified health center, which provides primary care services to uninsured, underinsured, and Medicaid patients. Your board of directors has ordered you to brief them on the grant funding and recommend a course of action. Specifically, the board chair has asked you to produce a policy memorandum for the board’s review.