2008 Agenda – Part Two

Protect the Medicaid Interests of Urban Safety-Net Hospitals

Whenever the federal government seeks to save money, it typically turns its attention to Medicaid. NAUH will identify and monitor any attempt to derive Medicaid savings at the expense of urban safety-net hospitals and respond appropriately to such efforts. In addition, NAUH expects to be involved in the following Medicaid-related issues in 2008.

• The federal budget. Last year, the administration proposed reducing federal Medicaid spending by $25 billion over a period of five years. Congress rejected those cuts, but NAUH expects at least some of them - and possibly others as well - to resurface in 2008. If and when they do, NAUH intends to speak out vigorously against any such cuts that would be harmful to urban safety-net hospitals.
  
  
• Legislation through regulation. With its budget-cutting efforts stymied by Congress, the administration has increasingly turned to attempting to legislate new policy through the regulatory process. It will continue to do so in 2008, Health and Human Services Secretary Mike Leavitt told a congressional committee in the fall of 2007. NAUH will identify proposed regulations that attempt to create new Medicaid policy, bring them to the attention of Congress, and advocate strongly against any such regulations that would change federal Medicaid policy at the expense of urban hospitals and without congressional assent.
  
  
• Extension of key Medicaid moratoriums. In 2008, the administration proposed new regulations to end federal matching funds for Medicaid graduate medical education (GME) payments and to limit the Medicaid payments states could make to public providers. Congress objected and passed a one-year moratorium on the implementation of those regulations. That moratorium ends in May of 2008, and NAUH will join others in advocating its extension for another year.
  
  
• SCHIP expansion. While Congress and the administration compromised on SCHIP expansion, essentially continuing the program in its current form until 2009, Congress may renew its efforts to expand the program in the coming year. If it does, NAUH will support SCHIP expansion.
  
  
• Medicaid eligibility expansion. In August of 2007, CMS advised states that it intended to limit their ability to expand Medicaid eligibility to more low-income residents. Before the year ended the administration backed up its words with actions, rejecting efforts by Louisiana, Ohio, and Oklahoma officials to expand Medicaid eligibility in their states. NAUH intends to follow this issue closely in 2008 and act, if appropriate.
  
  

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