State to restore hospital charity care fund, Medicaid enrollment growing faster than projected

A PHOTO OF the state capitol is taken from the Statehouse lawn in Providence./ COURTESY JACK NEWTON

PROVIDENCE — Executive Office of Health and Human Services’ Medicaid Director Patrick Tigue has recommended increasing the Medicaid Disproportionate Share Hospital funding to the state cap, $138.3 million, increasing the office’s $1.9 million deficit to $17.3 million in FY18 as the health coverage program’s enrollment increases faster than anticipated.

The office is reporting higher Medciaid enrollment growth for 2018 and 2019 than predicted in November 2017, a result of fine tuning to projections muddied by Unified Health Infrastructure Project enrollment errors and Medicaid expansion, said Ashley O’Shea, communications director at the Executive Office of Health and Human Services.

Tigue said due to progress made to repair the UHIP system, which manages enrollment for Medicaid, Supplemental Nutrition Assistance Program food assistance and other state aid programs, also known as Rhode Island Bridges, he’s confident the system is now reporting accurate enrollment figures for Medicaid.

The actual hurdle in projecting new enrollment lies in the office’s recent records, said O’Shea.

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“It is challenging to get an accurate, go-forward projection for Medicaid enrollment. This is because, in the recent past, we experienced the Medicaid Expansion Period, where we had significant growth, UHIP Phase 1 and UHIP Phase 2 and our most recent period, when we cleared up many UHIP system issues.  Therefore, this number represents our best estimate of future Medicaid enrollment,” O’Shea said.

The EOHHS expects medical benefits to cost $2.45 billion for an estimated 311,367 enrolled Rhode Island Medicaid members in FY18. The new estimate is 6,428 more than the 304,939 anticipated in November.

The office spent $1.7 million on capitation payments for the increased FY18 enrollment, according to O’Shea.

The office predicts a $17.9 million deficit in FY19, reported in the May 2018 Testimony of the Executive Office of Health and Human Services presented to the Caseload Estimating Conference Monday. For FY19, EOHHS projects $2.52 billion in expenditures on medical benefits. EOHHS estimates Medicaid enrollment for 2019 will be about 316,440, which is 16,152 more than estimated in November, according to the testimony document.

Tigue suggested raising the state DSH cap to the three-member CEC, which will decide whether to adopt the change for the proposed budget. The caseload estimating conferees are: Conference Chair Sharon Reynolds Ferland, House fiscal adviser, Steve Whitney, Senate fiscal adviser and Thomas Mullaney, state budget officer.

Hospital leaders have also been lobbying to restore state DSH funds. On April 11, hospital executives spoke before the House Committee on Finance’s Human Services Subcommittee hearing on the EOHHS’ proposed fiscal year 2019 budget, urging the restoration of state matching funds for the DSH, which reimburses hospitals for uncompensated care such as charity care.

Tigue said the federal government had planned a $32.3 million reduction in the DSH fund, leaving it at $106 million. In February 2018, Congress passed a short-term continuing resolution eliminating the reduction to DSH payments for FY 2018 and 2019, he said. Delaying the reduction should also restore the state match that goes with the funding, Tigue argued, allowing the state to increase the line item to $138.3 million.

The full federal piece is 51.45 percent of the $138.6 million, $71.3 million, according to O’Shea.

Rob Borkowski is a PBN staff writer. Email him at