The Kansas legislature’s failure to act on Medicaid expansion is costing Neosho County citizens dearly, according to Neosho Memorial Regional Medical Center CEO Dennis Franks.
Kansas is currently one of only 12 states to have yet to implement expanded Medicaid coverage, with South Dakota soon to bring that number to 11. Medicaid expansion affords states the opportunity to provide Medicaid coverage to people who earn up to 138 percent of the federal poverty level.
“There are 395 uninsured in Neosho County that would qualify for Medicaid expansion,” said Franks, a staunch proponent of the measure.
More than 225,000 adults and 38,000 children remain uninsured in Kansas.
“Since January 1, 2014, the state of Kansas has forfeited $5.9 billion,” Franks said of the legislature’s failure to expand Medicaid.
Franks added that the passage of Medicaid expansion would enable KanCare to create 23,000 new jobs. KanCare is the program through which the state administers Medicaid.
“There are about 150,000 hardworking people who cannot access coverage statewide,” he said. “Some don’t make enough money to afford quality insurance, but have incomes that are just slightly too high to qualify for KanCare.”
Franks said that expanding Medicaid eligibility would have an immediate impact of roughly $2.96 million to the local economy via annual healthcare spending.
“That’s a lot of money for Neosho County,” he said. “That’s the bottom line — it would help people who can’t get in here to get taken care of.”
Franks has extensive expertise in the area of Medicaid expansion, having spent nine years as a board member for the Kansas Hospital Association. That board has lobbied the Kansas legislature to pass Medicaid expansion on multiple occasions, failing to push it across the finish line each time.
“We got close,” Franks said.
The total annual net loss for NMRMC as it relates to Medicaid write-offs is projected to be $96 million for the year, a staggering figure according to Franks.
“The county is losing an average of $800,000 a month,” Franks said, noting that those costs are split between the categories of bad debt and charity care.
A portion of the princely sum is recouped through Medicare reimbursement. NMRMC Chief Financial Officer Katie Tinsley told The Tribune that the hospital is reimbursed 65 percent of its Medicare bad debt, but that it only accounts for a fraction of the estimated $800,000 monthly figure.
“We do get to claim and recoup 65 percent of those bad debts that are written off in that cost report year,” she said, referencing the unpaid beneficiary cost-sharing amount.
Franks said that monthly Medicaid costs have skyrocketed over the past year, and that NMRMC was previously on the hook for closer to $400,000 per month, attributing soaring inflation and other mitigating factors to the new average total.
Medicaid expansion would serve as a lifeline for hospitals in rural Kansas, Franks said.
“Obviously, hospitals are in bad shape right now in rural America,” he said, noting that seven rural Kansas hospitals have closed since 2015, including Mercy Health in Fort Scott. “If it does get passed, it will help out rural hospitals across Kansas. If it’s not passed when it comes around again, it’s going to hurt a lot of hospitals. There is no doubt about that.”
Franks said that the state needs further support from Governor Laura Kelly to make Medicaid expansion a reality. In a June interview with The Tribune, Kelly said that like food, healthcare and housing, she also views Medicaid expansion as a basic need for citizens of the state.
“I very much want to expand Medicaid. We should have done that a long time ago — it’s a concern that we haven’t done that,” she said. “But I will bring back another proposal next year to get that done.”
In a red state midterm shocker, South Dakota passed a ballot amendment to expand eligibility for Medicaid, overriding the resistance of hardline conservative Governor Kristi Noem. The program will cover more than 40,000 previously uninsured South Dakotans. The vast majority of states have adopted expansion by means of a governor’s order or through bills approved by the legislature. Due to the Kansas legislature’s supermajority stranglehold, Kelly’s hands are tied.
“Tell your friends and neighbors it’s time to vote this thing in. We need to get help throughout Kansas to make this happen,” Franks said. “I know that Governor Kelly wants to pass KanCare, but obviously there are others that don’t want it to pass, so we have to figure out a way to utilize the tools that we have at the state level to try to get people to understand how important it is for KanCare to pass.”
The federal government has previously offered incentives for states to expand Medicaid coverage. According to Politico.com, those incentives include covering an extra 5 percent of the cost associated with the program, in addition to the 90 percent it covers for newly-eligible individuals under the Affordable Care Act. The Kaiser Family Foundation estimates those incentives will disperse $110 million to South Dakota.
“I have friends in states that have expanded and they’re doing pretty good with those extra dollars,” Franks said. “With us being one of the 11 who haven’t passed it, that’s rough for our state.”
Like many hospitals across the US, NMRMC is experiencing a significant staffing shortage. Franks said NMRMC’s total workforce is down by 7 percent, equivalent to 30 of its 431 available jobs.
“Where people are going, I have no idea,” Franks said. “We have to stay on top of that to make sure that we have the right staff.”
Franks equated staffing woes to that of a roller coaster ride.
“You can make changes to try to get people to come to work here, but everybody else is doing the same thing,” Franks said.
Despite the need to staff up, Franks said that NMRMC is in good overall health.
“I think we’re doing quite well compared to other hospitals,” he said, adding that they’ve been kicking recruiting efforts into high gear. “We’re recruiting all the time.”