For years, nearly every Illinois hospital has paid into a pot of money that helps the state bring in more federal dollars. But the program, effectively a tax on hospitals, is dated and doesn't reflect how much the health care industry has changed.
Now, state lawmakers, the Rauner administration and lobbyists want to modernize the hospital assessment program, shaking up how it doles out money to medical centers across the state. Currently, it redistributes funds based on claims data for Medicaid services provided in the hospital in 2005 and on an outpatient basis in 2009.
The potential overhaul is causing major anxiety among hospital executives. A public hearing about the potential changes is scheduled in the Loop on Jan. 11.
"The hospital tax assessment is our lifeblood," said Tim Egan, CEO of Roseland Community Hospital on the Far South Side. "Without it, you're going to see a massive string of hospitals shut down in Illinois."
Roseland, for example, contributes $3.8 million to the hospital assessment program each year, yet gets back about $23 million. That represents nearly half of the hospital's total budget.
The program, which is set to expire July 1, works this way. Each year, medical centers give a fixed amount of money to the state based on a formula that accounts for how many beds were full in 2005 and how much outpatient revenue was grossed in 2009. Illinois then sends it off to the federal Centers for Medicare & Medicaid Services for a match to generate a total of $3.5 billion for the state. Most of the money flows back to hospitals, but some goes to other services, including long-term care. The $3.5 billion pot represents about 16 percent of the budget for the Illinois Department of Healthcare & Family Services, which runs Medicaid.
The reality is that a lot has changed. Low-income Chicago neighborhoods that surround safety-net hospitals have emptied out, dwindling their patient base. The push toward outpatient care means fewer people need to be hospitalized. At the same time, the state expanded Medicaid under the Affordable Care Act, leading to crops of new patients who sought care elsewhere. The bottom line: The current assessment program doesn't reflect where Medicaid patients seek treatment.
"It's a tough process to renegotiate," said Rep. Greg Harris, a Chicago Democrat who is among the state lawmakers working to redesign the program. "Every hospital in the state is affected. There will be winners and there will be losers."