Gov. Mike Pence isn’t the only one waiting to learn how federal health department officials feel about the state’s application to extend Medicaid services to tens of thousands of new patients by linking expansion to the Healthy Indiana Plan, which already covers 41,000 low-income Hoosiers.
Also watching is Beth Morris, director of community health partnerships at Columbus Regional Hospital, and one of the hospital brain trust that helps guide the Volunteers in Medicine free clinic in the 800 block of Jackson Street.
Morris said decisions at the state and federal level about expanding Medicaid, largely with federal funds, are a big key to how many patients will visit the Volunteers’ clinic in the future and how they’ll be served.
Morris said she sits on a committee that has begun meeting to brainstorm what the future might look like for Volunteers in Medicine. The panel includes key personnel from the clinic, including the head of Spanish-speaking services there, and several top administrators from Columbus Regional Hospital.
The hospital’s foundation provides the lion’s share of funding for Volunteers in Medicine. The free clinic serves people who have no government or private insurance and no other access to medical care.
“We don’t know when Health and Human Services will respond to the state,” Morris said. “We’ve been told that any kind of Medicaid expansion depends on the dollars in the state’s biennial budget. And we won’t see revenue projections for the state until sometime in April.”
That scenario leaves a lot of questions unanswered for the time being.
Columbus Regional’s leadership is encouraging Pence and state legislators to accept federal dollars to expand Medicaid coverage to more Hoosiers.
But Morris cautions that even with expanded Medicaid, there will be many poor patients who fall through the cracks and come to Volunteers in Medicine seeking free care. The clinic operates with a small staff and relies on doctors and dentists in the community to provide free services.
Some estimates are that expanding Medicaid — due to more generous income rules under federal health reform — will push another 406,000 low- to moderate-income Hoosiers into the system by the end of the decade.
Columbus Regional officials argue that expanding Medicaid coverage is a good idea because the alternative is to push lower-income patients into hospital emergency rooms and ask hospitals to provide more charity care that eats into their bottom lines.
No matter how the Medicaid debate plays out, though, Morris said the Volunteers in Medicine clinic will always have a role to play.
“We know there will always be groups of people who won’t be covered by health care reform, and we know there will be a need for Volunteers in Medicine beyond 2014 when the Affordable Care Act takes full effect,” Morris said last week.
Pence’s stance up to this point has been a flat refusal to expand Medicaid unless the state can couple the program with the Healthy Indiana Plan, which promotes preventive care and shifts some costs to participants in the form of co-pays.
Last month, Pence received a letter from Kathleen Sebelius, the federal government’s Health and Human Services secretary, saying the state must hold public hearings on its bid to use Healthy Indiana to extend Medicaid services. Pence has argued that traditional Medicaid is broken and plagued by “waste, corruption and abuse.”
“We’re reading everything we can, trying to understand the meaning and impact,” Morris said.
One issue being discussed at the Volunteers in Medicine study committee is whether there are enough doctors and other providers in the community to handle a flood of new Medicaid patients, Morris said.
If providers can’t handle the volume, one possibility — although not necessarily the most likely scenario — would be for Volunteers in Medicine to start seeing some Medicaid patients at its Jackson Street clinic, Morris said.
Right now, the clinic won’t see patients covered by Medicaid or any other form of insurance.
One option being discussed in these very early stages would be to establish two legal entities under one roof at Volunteers in Medicine, with one side of the house not seeing Medicaid patients and another legally established clinic accepting federal payments.
“It would be two separate clinics under the same roof,” Morris said, stressing that such a decision hasn’t been made yet.
“If local providers can make room (for more Medicaid patients), that would be the first option,” she said.