Fund that paid for uninsured at University Hospital scrapped after Medicaid expansion changes landscape
A special government fund set up in 1983 to help pay for uninsured patients at University of Louisville Hospital, the city’s safety net hospital for the poor, will be dissolved soon as officials say it’s no longer needed because of Kentucky’s expansion of Medicaid.
LOUISVILLE, Ky. (WDRB) -- A special government fund set up in 1983 to help pay for uninsured patients at University of Louisville Hospital, the city’s safety net hospital for the poor, will be dissolved soon as officials say it’s no longer needed because of Kentucky’s expansion of Medicaid.
A board chaired by the secretary of Gov. Matt Bevin’s health cabinet voted Thursday to dissolve the Quality and Charity Care Trust Inc., or QCCT.
The trust had been funded by the state, Louisville Metro government and the University of Louisville.
But the 2014 expansion of Medicaid to cover more of Kentucky’s low-income population has cut the percentage of uninsured patients at the hospital from about 25 percent to 5 to 6 percent, said Dr. Greg Postel, U of L’s interim president and executive vice president for health affairs.
That means the hospital is able to bill Medicaid for a lot of care that was previously funded by city and state dollars put into the trust.
Bevin vetoed state funding for QCCT last year, and the trust has no remaining assets. The hospital’s last request for trust funding was over a year ago.
The move to dissolve the trust comes despite the fact that changes could be in store for the state’s Medicaid program.
Bevin is seeking federal approval to add requirements like work or volunteering and premium payments for some of Kentucky’s Medicaid recipients, and Republicans in Congress are making efforts to repeal and replace the Affordable Care Act, which allowed states such as Kentucky to expand Medicaid.
Postel and Vickie Yates Brown Glisson, secretary of the state Cabinet for Health and Family Services, said the issue of public funding for University Hospital could be raised again down the road, if needed.
“The hospital is fine as things are today, but if Medicaid changes, then some kind of safety net would have to be reestablished,” said Postel, a member of the board that unanimously voted Thursday to end the trust.
Glisson, who chairs that same board, said, “I think everybody is going to watch what’s happening on a federal level and if things change, we may need to come back and look at this situation.”
There’s no point in keeping the trust around without the city and state funding it, and an organization like the trust would not be difficult to recast in the future if needed, Postel said.
Glisson added that she doesn’t think University Hospital will see more uninsured patients as a result of the Medicaid waiver Bevin is seeking.
“These individuals (who got coverage through the expansion) are still eligible. The only thought would be that … if you are able-bodied, with no dependents, that you will make that personal choice to now go into the job market … and that they would then be covered by their employer-sponsored insurance,” she said. “…Nobody is losing their insurance; nobody is being pushed off.”
Glisson said there were other Affordable Care Act changes besides Kentucky’s Medicaid expansion that contributed to the big drop in uninsured patients at the hospital, like the requirement that all Americans get health insurance or pay a penalty.