“The practical impact is that the federal anti-kickback statute isn't going to apply,” said Ankur Goel, attorney with McDermott Will & Emery, adding that several of his clients have asked specifically about this issue.
The Patient Protection and Affordable Care Act mandated the creation of websites where consumers could buy affordable coverage. The law also established federal subsidies for low- and middle-income buyers who earned too much to qualify for Medicaid coverage but not enough to be able to afford coverage outright.
The question was whether those subsidies transformed the coverage into a “federal healthcare program” for the purposes of the anti-kickback statute, which bars providers from exchanging anything of value to generate business paid for by Medicare and other government health programs.
Goel noted that the HHS letter doesn't mean hospitals can help the uninsured buy policies after they arrive at an emergency department because coverage isn't effective immediately. He also said there could be additional restrictions in state laws.
Last month, University of Wisconsin Health announced that it would donate $2 million in a one-year pilot program to help about 7,300 people who live near Madison afford to buy coverage through the new state insurance exchange. The money is going to United Way of Dane County, which will coordinate the program.
The initiative came about after the state changed its Medicaid eligibility rules and disqualified about 92,000 low-income residents statewide for Medicaid coverage.
Follow Joe Carlson on Twitter: @MHJCarlson