CMS Regulatory Policy
Background
The National Association of Community Health Centers (NACHC) analyzes and informs the development and implementation of Medicaid and Medicare policies. NACHC will post newly released regulations that may significantly impact health centers and their patients. In addition, health center staff and their patients can access NACHC-authored comments and correspondence to CMS advocating for positions designed to promote health centers and protect them from adverse policy initiatives. The association will publish its bi-monthly publication; the Medicare and Medicaid Federal Policy Update as a benefit to NACHC members. This publication will provide analysis and information on the status of Medicare and Medicaid rules and guidance, key policy developments, new studies, and other CMS-related information. Lastly, below you can access recent health center specific cases law and legal analyses.
Medicaid
More than one-third of all FQHC patients have Medicaid coverage. However, Medicaid covers only 9% of private, office-based physician visits, and only half of office-based physicians are willing to accept all new Medicaid patients and one-fifth are no accepting any. FQHC patients are therefore more likely than the general population to be enrolled in Medicaid, with 36% of all FQHC patients enrolled in the program compared to 13% nationally.
Overall the number of Medicaid patients seen at FQHCs continue to grow. In fact, the number of health center Medicaid patients grew twice as fast as the number of Medicaid beneficiaries nationally – 51% vs. 26% between 1999 and 2003.
Medicare
Both health centers and Medicare serve an important role in the lives of many elderly and disabled Americans. Millions of elderly and disabled American’s rely on Medicare to finance needed care, while health centers directly deliver high quality, affordable, and accessible primary and preventive health care to anyone in need. For many Medicare beneficiaries, health centers may be the only source of care available to them. Although these patients make up only 7.5% of all health center patients, the number of health center Medicare patients has grown 43% since 2001, slightly faster than the number of patients with other forms of insurance. Moreover, the number of patients ages 55-64 is growing much faster than the number of patients ages 65 and over, speaking to health center’s growing role in serving patients who age into Medicare.
Currently, health centers serve 1.2 million Medicare beneficiaries. Because the vast majority are low income, health centers serve disproportionately high numbers of dual eligibles (patients who have both Medicare and Medicaid). Dual eligibles have extensive health care needs, and rely on both Medicaid and Medicare to help pay for their care, as well as on health centers to deliver needed care.
