States across the country are considering Medicaid cuts to shore up budget shortfalls caused by the COVID-19 pandemics, and federal restrictions could mean the brunt of cuts could fall on provider payments.
Governors in New York, California, Colorado, Ohio, Alaska, and Georgia have already indicated they plan to cut Medicaid spending. Congress increased federal matching funds in its second COVID-19 relief package, but included restrictions that leave states few options to cut Medicaid other than slashing provider payments. If pay cuts aren't targeted, they could inflict further damage on safety-net providers that have already been disadvantaged by formulas to distribute federal assistance.
The Families First Coronavirus Response Act, passed on March 18, bumped federal Medicaid matching funds by 6.2%. But the money came with conditions. To receive the funds, states had to agree to not restrict eligibility, increase premiums, or kick beneficiaries off of Medicaid rolls.
Additional CMS guidance says that states also have to maintain benefits if they want to keep federal funds, but Kaiser Family Foundation vice president Robin Rudowitz said there is some ambiguity about exactly how stringent that restriction is. For example, California Gov. Gavin Newsom (D) proposed cutting optional benefits. Regardless, states are left with few options to achieve general fund savings.
"I think the choices are pretty limited and none of them are great," Rudowitz said.
In Colorado, hospitals could be facing roughly $200 million to $250 million in Medicaid pay cuts and increased provider fees as state lawmakers wrangle with the budget this week, Colorado Hospital Association senior vice president Katherine Mulready said. The association calculated that even after accounting for projected federal provider relief grants, hospitals across the state are facing a $3 billion shortfall.
"These cuts are dire," Mulready said.
New York has already passed a $400 million cut to hospitals. Greater New York Hospital Association President Kenneth Raske said he thinks the cuts were targeted well to protect safety-net hospitals, but he worries more cuts could be coming if Gov. Andrew Cuomo (D) makes good on his warning that hospitals could face 20% cuts if the federal government doesn't help.
Raske said the reality of budget shortfalls may outweigh what he views as the injustice of cutting provider payments during a pandemic.
"The states are getting hammered, and everyone realizes there are only so many places they can go. The morality may be unjust, but the fiscality of it is real," Raske said.
Beyond decreasing revenue, states are also facing increased Medicaid enrollment and many states expect Medicaid budget shortfalls next fiscal year, according to a survey by the Kaiser Family Foundation.
States have to make significant Medicaid program cuts to see general fund savings because every dollar in state cuts also cuts federal matching money, said Center on Budget and Policy Priorities senior fellow Judith Solomon. That means some providers could see substantial cuts.
In 2009 when a federal relief package stopped states from restricting eligibility, they turned to provider pay cuts, per data from the Kaiser Family Foundation. In 2008, 21 states enacted at least one provider rate restriction or cut. That number had nearly doubled to 39 states in 2010.