Skip to main content
Subscribe
  • Sign Up Free
  • Login
  • Subscribe
  • News
    • Current News
    • Providers
    • Insurance
    • Government
    • Finance
    • Technology
    • Safety & Quality
    • Digital Health
    • Transformation
    • ESG
    • People
    • Regional News
    • Digital Edition (Web Version)
    • Patients
    • Operations
    • Care Delivery
    • Payment
    • Midwest
    • Northeast
    • South
    • West
  • Blogs
    • AI
    • Deals
    • Layoff Tracker
    • HIMSS 2023
  • Opinion
    • Breaking Bias
    • Commentaries
    • Letters
    • From the Editor
  • Events & Awards
    • Awards
    • Conferences
    • Galas
    • Virtual Briefings
    • Webinars
    • Nominate/Eligibility
    • 100 Most Influential People
    • 50 Most Influential Clinical Executives
    • Best Places to Work in Healthcare
    • Excellence in Governance
    • Health Care Hall of Fame
    • Healthcare Marketing Impact Awards
    • Top 25 Emerging Leaders
    • Top Innovators
    • Diversity in Healthcare
      • - Luminaries
      • - Top 25 Diversity Leaders
      • - Leaders to Watch
    • Women in Healthcare
      • - Luminaries
      • - Top 25 Women Leaders
      • - Women to Watch
    • Digital Health Transformation Summit
    • ESG: The Implementation Imperative Summit
    • Leadership Symposium
    • Social Determinants of Health Symposium
    • Women Leaders in Healthcare Conference
    • Best Places to Work Awards Gala
    • Health Care Hall of Fame Gala
    • Top 25 Diversity Leaders Gala
    • Top 25 Women Leaders Gala
    • - Hospital of the Future
    • - Value Based Care
    • - Hospital at Home
    • - Workplace of the Future
    • - AI and Digital Health
    • - Future of Staffing
    • - Hospital of the Future (Fall)
  • Multimedia
    • Podcast - Beyond the Byline
    • Sponsored Podcast - Healthcare Insider
    • Sponsored Video Series - One on One
    • Sponsored Video Series - Checking In with Dan Peres
  • Data & Insights
    • Data & Insights Home
    • Hospital Financials
    • Staffing & Compensation
    • Quality & Safety
    • Mergers & Acquisitions
    • Data Archive
    • Resource Guide: By the Numbers
    • Surveys
    • Data Points
  • Newsletters
  • MORE+
    • Contact Us
    • Advertise
    • Media Kit
    • Jobs
    • People on the Move
    • Reprints & Licensing
MENU
Breadcrumb
  1. Home
  2. Providers
The ACA after 10 years: Repair or replace?
March 14, 2020 12:00 AM

Intergovernmental transfers in practice and theory

Alex Kacik
  • Tweet
  • Share
  • Share
  • Email
  • More
    Reprints Print
    Parkland Health & Hospital System in Dallas

    Parkland Health & Hospital System in Dallas

    The Lone Star State’s approach to intergovernmental transfers

    Parkland Health & Hospital System in Dallas administers one of Texas’ 28 local provider participation funds that generate a portion of the state’s share of Medicaid matching payments.

    Local governments impose an assessment up to 6% on the net patient revenue of private hospitals to use as an intergovernmental transfer to Texas Health and Human Services. “Texas as a whole has a lot of oversight from the Medicaid agency on waiver programs, requiring reporting and transparency in how the funding works and what it is used for,” said Katherine Yoder, vice president of government relations at Parkland. “There has been misinformation about the transparency side.”

    Ken Janda, principal at Wild Blue Health Solutions, a consultancy in Houston, said he has been trying to untangle the complex Medicaid system for 12 years. A proposed Medicaid fiscal accountability regulation is encouraging, though, because intergovernmental transfers, local provider fees and other finance mechanisms are so opaque, he said, adding, “The most frustrating thing is the lack of transparency and lack of accountability of how much money there is, where it is going and what it is being used for.”

    Texas’ Uniform Hospital Rate Increase Program, which is paid through managed-care plans, is intended to cover hospitals’ Medicaid shortfall. Hospitals can charge supplemental increases above the Medicaid base rate to pay for the shortfall, but the increases seem somewhat arbitrary, Janda said.

    Managed-care plans add a percentage to the base rates, often ranging from 30% to 50%, and the hospitals reconcile those numbers at year-end, he said. “The concept isn’t a bad one, but we should understand how it works and it shouldn’t be as opaque as it is now,” Janda said. There is speculation that some of the UHRIP dollars go to consultants, not the hospitals, he said.

    How intergovernmental transfers can benefit states

    Suppose a state made a $100 million Medicaid disproportionate-share hospital payment to a county hospital, of which $50 million was reimbursed by the federal match, said Katherine Baicker, dean of the University of Chicago Harris School of Public Policy and healthcare economics professor who has studied Medicaid financing.

    If the county then transferred $50 million back to the state in the form of an intergovernmental transfer, the state would have made no net contribution.

    HHS’ Office of Inspector General found that supplemental Medicaid payments in six states were not based on the actual cost of care, nor were they used to improve care, according to a 2001 report. Hospitals would return the majority of Medicaid DSH funding to the state through intergovernmental transfer. That would maximize federal reimbursements without states committing their share of the required matching funds, regulators found.

    “The federal government writes down a set of rules, then states figure out how to maximize access to those assets. The federal government closes that loophole and then states would find another,” Baicker said. “States would be able to reprogram resources in ways that are not the intention of the DSH provision while complying with the law.”

    DSH dollars were stickier in some states, but it isn’t a consistently effective mechanism to ensure funding goes to the underserved, she said.

    MORE FROM THE ACA ISSUE

    Related Article
    Patients slip through healthcare's safety net amid Medicaid financing debate
    Letter
    to the
    Editor

    Send us a letter

    Have an opinion about this story? Click here to submit a Letter to the Editor, and we may publish it in print.

    Recommended for You
    Patrick Blair InnovAge
    PACE could expand amid possible nursing home closures: InnovAge CEO
    Rob Allen Intermountain 23
    Intermountain's Graphite Health may be AI 'grounding point,' CEO says
    Most Popular
    1
    CMS tries luring providers to revamped Medicare ACOs
    2
    Oregon joins other states in setting ratios for nurse staffing
    3
    Blue Shield CA taps Amazon, Mark Cuban, CVS for new PBM model
    4
    A health innovation hub grows in Lake Nona Medical City
    5
    Hospital-at-home providers push for Medicaid coverage
    Sponsored Content
    Modern Healthcare A.M. Newsletter: Sign up to receive a comprehensive weekday morning newsletter designed for busy healthcare executives who need the latest and most important healthcare news and analysis.
    Get Newsletters

    Sign up for enewsletters and alerts to receive breaking news and in-depth coverage of healthcare events and trends, as they happen, right to your inbox.

    Subscribe Today
    MH Magazine Cover

    MH magazine offers content that sheds light on healthcare leaders’ complex choices and touch points—from strategy, governance, leadership development and finance to operations, clinical care, and marketing.

    Subscribe
    Connect with Us
    • LinkedIn
    • Twitter
    • Facebook
    • RSS

    Our Mission

    Modern Healthcare empowers industry leaders to succeed by providing unbiased reporting of the news, insights, analysis and data.

    Contact Us

    (877) 812-1581

    Email us

     

    Resources
    • Contact Us
    • Help Center
    • Advertise with Us
    • Ad Choices
    • Sitemap
    Editorial Dept
    • Submission Guidelines
    • Code of Ethics
    • Awards
    • About Us
    Legal
    • Terms and Conditions
    • Privacy Policy
    • Privacy Request
    Modern Healthcare
    Copyright © 1996-2023. Crain Communications, Inc. All Rights Reserved.
    • News
      • Current News
      • Providers
      • Insurance
      • Government
      • Finance
      • Technology
      • Safety & Quality
      • Digital Health
      • Transformation
        • Patients
        • Operations
        • Care Delivery
        • Payment
      • ESG
      • People
      • Regional News
        • Midwest
        • Northeast
        • South
        • West
      • Digital Edition (Web Version)
    • Blogs
      • AI
      • Deals
      • Layoff Tracker
      • HIMSS 2023
    • Opinion
      • Breaking Bias
      • Commentaries
      • Letters
      • From the Editor
    • Events & Awards
      • Awards
        • Nominate/Eligibility
        • 100 Most Influential People
        • 50 Most Influential Clinical Executives
        • Best Places to Work in Healthcare
        • Excellence in Governance
        • Health Care Hall of Fame
        • Healthcare Marketing Impact Awards
        • Top 25 Emerging Leaders
        • Top Innovators
        • Diversity in Healthcare
          • - Luminaries
          • - Top 25 Diversity Leaders
          • - Leaders to Watch
        • Women in Healthcare
          • - Luminaries
          • - Top 25 Women Leaders
          • - Women to Watch
      • Conferences
        • Digital Health Transformation Summit
        • ESG: The Implementation Imperative Summit
        • Leadership Symposium
        • Social Determinants of Health Symposium
        • Women Leaders in Healthcare Conference
      • Galas
        • Best Places to Work Awards Gala
        • Health Care Hall of Fame Gala
        • Top 25 Diversity Leaders Gala
        • Top 25 Women Leaders Gala
      • Virtual Briefings
        • - Hospital of the Future
        • - Value Based Care
        • - Hospital at Home
        • - Workplace of the Future
        • - AI and Digital Health
        • - Future of Staffing
        • - Hospital of the Future (Fall)
      • Webinars
    • Multimedia
      • Podcast - Beyond the Byline
      • Sponsored Podcast - Healthcare Insider
      • Sponsored Video Series - One on One
      • Sponsored Video Series - Checking In with Dan Peres
    • Data & Insights
      • Data & Insights Home
      • Hospital Financials
      • Staffing & Compensation
      • Quality & Safety
      • Mergers & Acquisitions
      • Data Archive
      • Resource Guide: By the Numbers
      • Surveys
      • Data Points
    • Newsletters
    • MORE+
      • Contact Us
      • Advertise
      • Media Kit
      • Jobs
      • People on the Move
      • Reprints & Licensing