The Commonwealth Health Center as it is right now cannot handle the influx of new Medicaid patients who used to go private clinics to seek treatment and other medical services, according to the Commonwealth Healthcare Corp. CEO Juan N. Babauta.
He cited the hospital's funding shortfall as a major barrier to adding more personnel that will handle the expected increase in patients, now that most private clinics are turning away Medicaid patients.
To accommodate more than the usual number of Medicaid dependents would require the hospital to bring in more personnel and add services such as ophthalmology and dental services, which the hospital since stopped, Babauta said.
“.Moving Medicaid patients to CHC is not a sound policy.because we need to beef up our personnel and we will be carrying the burden of people who are not paying. With the amount of money and the resources we have, CHC is not ready for the influx [of patients from private clinics] unless the Legislature will increase the funding for the hospital and the Medicaid program,” said Babauta.
He is hopeful, however, that the Senate will provide additional funds for Medicaid when it deliberates on the budget bill for the new fiscal year.
The House of Representatives had just passed a budget bill that allocates only $1.2 million for the Medicaid program for fiscal year 2013-far lesser than the 2012 budget of $2.4 million.
Babauta disclosed that in order to drawdown up to $32 million in Medicaid reimbursements, the CNMI has to come up with about $14 million in local matching funds that the federal side will match with $18 million.
But with what's been happening at the Legislature, Babauta is losing hope that the budget proposal for Medicaid will dramatically change.
He said Medicaid currently has about 19,000 eligible clients who are seeking services both in private clinics and the hospital. This number is projected to increase to 35,000 to 40,000 when the national poverty level of 133 percent is used beginning 2014.
From the corporation's fiscal standpoint, he believes that moving Medicaid to CHC is sound policy because it means additional reimbursement amount for CHC. But the fact that Medicaid has no funding for the reimbursements, he said, will just add to its long-list of unpaid obligations.
Babauta believes that some private clinics “abuse” the Medicaid program because there's no utilization review and this can be prevented once Medicaid patients move to CHC.
He cited as example the duplication of prescription drugs and some unnecessary doctor visits that remain unchecked up to this time.
Under the new state plan for the Medicaid program, Medicaid patients who go to private clinics will need to be certified first by CHC that the service the patient requires is not available at the public hospital.
Babauta pointed out, however, that all decisions on where a patient can be referred to is up to Medicaid program director Helen C. Sablan.
“I will just certify the availability of services, but Medicaid makes the final decision.not me or the CHC,” he told Saipan Tribune.
Babauta earlier disclosed that the Center for Medicare Medicaid Services had initially approved the use of the corporation's $5 million seed money as additional matching funds for the Medicaid program. The $7 million line of credit from Marianas Public Land Trust is also being proposed for the same purpose, which is undergoing federal review.
According to the CEO, the corporation will also seek some $800,000 in local allocation for the Tinian medical referral and other health services to be used as additional matching funds for Medicaid.
Medicaid is a federal/state operated program designed for low-income citizens. At present, the CNMI shares 45 percent of the operational funding while 55 percent is funded by the federal government. In the Commonwealth, the program is being administered under the Executive Branch in collaboration with the public hospital.