Medicaid change to impact EMS

Apr. 28, 2013 @ 07:03 PM

Revenues for emergency services could be in flux until the state decides what to do with Medicaid.
Many patients served by Guilford County EMS are covered by Medicaid, Jim Albright, interim EMS director, told county commissioners recently. About 16 percent of county residents have no health insurance.
“So far, there has been no Medicaid expansion, and we are impacted by that,” Albright said. “Some people have no other way to pay, and some may not be eligible for Medicaid with the changes, so they will go to the emergency rooms for help.”
Gov. Pat McCrory announced reforms for the program that spends about $13 billion in state and federal funds a year to provide health coverage for more than 1.5 million mostly poor children, older adults and the disabled. Instead of expanding Medicaid as part of the Affordable Health Care Act, the McCrory administration decided for now to review Medicaid for inefficiencies and to create private providers, or “comprehensive care entities,” to determine the best treatment and create a network of health care providers.
Under the new law, people below the poverty line can only get taxpayer-subsidized coverage by going into Medicaid. But other low-income people making just enough to put them over the poverty line can get subsidized private insurance through new state markets as they are developed.
For example, a person making $11,700 a year would be able to get a policy. But someone making $300 less would be dependent on charity care.
It may take time for people to figure out what to do, Albright said.
As the baby boomer generation ages, EMS will attend to more elderly patients on Medicare, Albright said. In 2010, 49 percent of EMS patients were above age  55.
“Health care will see more changes in the next few years than we have seen in decades,” Albright said. “The emphasis will shift to keeping people healthy rather than paying out so much when they get sick. Instead of having a few choices, people will have more choices in Medicare.”
EMS is one government agency that has revenues, about $12 million a year from services and other sources. The ambulance ride scale starts at $250 for a non emergency ride to the hospital. Advanced life support costs more than $700.

dnivens@hpe.com|888-36426
The Associated Press contributed to this report.


Medicaid

Expansion: The Affordable Care Act required states to accept Medicaid expansion as a condition of staying in the program until the U.S. Supreme Court gave each state the right to decide.

Patients: About half the nearly 30 million uninsured people expected to gain coverage under health care reform would do so through Medicaid. The expansion would cover low-income people making up to 138 percent of the federal poverty level, about $15,860 for an individual.