As a result, co-payments and insurance premiums will increase. It is also important to note that cost shifting is only viable for those institutions that have a sufficient commercial population base. By definition, Medicaid disproportionate share providers have limited ability to shift costs because of their significant Medicaid and uncompensated care burdens. In recognizing the critical needs of children and the pediatric services they receive, IDPA made a conscious decision to exclude children s hospitals from the charge cap. The IHHA strongly supports that decision, but questions whether the Department went far enough to address services of Illinois, neediest citizens.
Analysis indicates that the service area most affected by the charge cap is perinatal care.
The impacts are great because these are typically costly and complex cases. The DRG weight, and thus the payment, is so high because the average length of stay for babies with these symptoms is 24 days. It hardly seems fair, much less financially viable, if a hospital is forced to absorb thousands of dollars in costs on cases more complex than average, but IDPA benefits on less complex cases. Medicaid clients represent over one third of all newborns in Illinois and an even larger percentage of the perinatal cases. IHHA strongly encourages the Department to exclude perinatal services from the charge cap.