The health care safety net is especially important for persons experiencing homelessness, nearly three-quarters of whom have no form of health insurance. Health care safety net providers facilitate access to the broad range of health and social services required by individuals experiencing homelessness. These include outreach, transportation, translation, and case management, as well as preventive, primary, and related health services. Federal grant funds received by HCH projects and other health centers pay for only a small portion of the services they deliver. In return for meeting stringent quality standards and for serving all indigent members of their communities, Medicaid has guaranteed payments to federally qualified health centers, including HCH projects, for the reasonable cost of serving Medicaid beneficiaries.
Reasonable costs are determined in negotiation between the provider and the state.
This system ensures that federal grant funds intended to provide health care to uninsured persons do not subsidize Medicaid underpayments. Many health centers will be forced to use federal grant and other funds now designated for services to uninsured patients to balance the cost of care for Medicaid patients, thereby reducing or eliminating services for patients who lack health insurance. This loss in funds for preventive and primary health services for uninsured persons not only jeopardizes the health and quality of life of many Americans, it also leads to higher public costs in the form of increased publicly-funded urgent and emergency care. Accordingly, we urge Congress and the Administration to ensure that Medicaid payments to federally qualified health centers for their services to Medicaid beneficiaries cover the full cost of providing such services. We urge Congress and the Administration to establish a prospective payment system for HCH projects, other federally qualified health centers, and rural health clinics for their services to Medicaid beneficiaries.