Myths and Facts

MYTH: Doctors and hospitals are paid what it costs them to treat Medicaid recipients.
FACTS:

  • Doctors in Georgia are paid 30% less for treating Medicaid patients than what the federal government pays for treating Medicare patients.
  • On average, the state pays hospitals 84 cents for every $1 hospitals spend treating Medicaid patients.
  • Healthcare providers are not even paid what it COSTS them to provide the care let alone receive money to maintain a modern facility and keep current with technology.
  • Like all businesses, they can’t provide services for less than cost.
  • ACCESS Healthcare is asking that Georgia’s doctors, dentists, nursing homes and hospitals get paid reasonable costs for treating Medicaid patients.

MYTH: The underfunding issue affects only a small percentage of the population.
FACTS:
  • As Medicaid underfunding continues, losses are passed on to businesses in the form of annual double-digit insurance premium increases.
  • Local governments will feel increasing pressure to help cover the funding shortfalls.
  • Communities’ economic vitality - job growth, business relocations, and county health clinics - is directly related to healthcare providers’ economic viability.
MYTH: Georgia spends enough money on Medicaid.
FACTS:
  • Only 13 states spend less than Georgia in treating Medicaid-enrolled children.
  • Georgia ranks 39th in Medicaid spending per enrollee.
  • Medicaid underfunding and our healthcare status are directly related: On a scale where 1 is best and 50 is worst, Georgia ranks 42nd in infant mortality rates, 37th in obesity rates and 32nd in babies born prematurely.
  • For every $1 Georgia spends, the federal government contributes $2. Georgia is leaving federal money on the table - money that now goes to other states.
MYTH: Hospitals are already reimbursed 94-97 percent of their costs.
FACTS:
  • The rate compares FY ’09 payments to FY ’05 costs. This is not an “apples-to-apples” comparison. In reality, hospitals are reimbursed today at about 84% of costs, on average. The last increase for inpatient hospital treatment was FY 2003. Rate reductions occurred in 2004 and 2006.
  • Hospitals experienced a $270 million shortfall
  • Physicians are also underpaid. Medicare is supposed to pay physicians “reasonable costs.” Currently, Medicaid pays on average only 85% of the amount Medicare paid in 2000!

MYTH: An increase in Medicaid funding is another way to expand an entitlement program.
FACT:
  • The requested funding is not intended for expansion of Medicaid. It is only to cover the cost of the current program. Hospitals and physicians merely want to be paid what it costs to provide healthcare services to Georgia’s 1.7 million Medicaid recipients. Continued failure to do so will result in a deterioration of healthcare access and services for all Georgians.

MYTH: The Indigent Care Trust Fund already makes up the existing Medicaid payment shortfalls to hospitals.
FACT:
  • Hospitals spend almost $1 billon annually taking care of patients who have no insurance or are underinsured. The Indigent Care Trust Fund only provides about $400 million annually to address the shortfall.