A Florida hospital’s medical care for Medicaid patients is more than just a cash-in deal

As more states expand Medicaid, it’s becoming increasingly clear that the way hospitals treat their Medicaid patients will affect how they do business in the future.

In a recent study, Florida’s largest health insurer, Florida Hospital Association, revealed that, of the 6.8 million Medicaid patients who received medical care at a hospital in Florida between March 1, 2013 and June 30, 2015, about 1.3 million had their care for $100 or less in medical care billed to them.

As of June 30 of this year, the average medical care bill for Medicaid beneficiaries was $4,094, and it’s likely the same for Medicare beneficiaries as well. 

The Florida Hospital association’s study is important because it highlights the importance of transparency in the health care delivery system.

While hospitals do have a legal obligation to collect the fees that Medicaid beneficiaries pay to their healthcare providers, the information the hospitals release is usually redacted.

In contrast, the Florida Hospital’s data is open, and there’s no reason hospitals shouldn’t be able to share their data to help inform the conversation about Medicaid. 

According to the study, more than 80 percent of Medicaid beneficiaries have multiple medical care providers, and Medicaid payments were paid by Medicaid to hospitals for care for multiple care providers.

For patients with multiple providers, Medicaid was also billed at a higher rate, although the researchers said that the Medicaid payment rates for these patients were similar to Medicaid patients without multiple providers. 

“The data we have shows that Medicaid patients pay more for medical care because of the way they’re billed, which is very, very different from Medicaid patients with no medical providers,” said Erin Cottrell, CEO of Florida Hospital and Health System, in a press release.

“These data provide a clearer picture of the Medicaid billing patterns that affect Medicaid beneficiaries.”

The Florida Health Insurance Association also released a report that found that nearly 3 in 4 Medicaid beneficiaries received at least one medical bill for at least $100, and the average Medicaid beneficiary bill for care was $2,085.

In this same study, the health insurers found that the average payment rate for Medicaid was $1,966, but the insurance companies said that for Medicare, the payment rate was $3,894. 

In total, about 12 percent of the 4.1 million Medicaid beneficiaries in the study had multiple medical providers, according to the Florida Health Association.

Of those, 543,000 received care for a total of 1.2 million Medicaid and Medicare beneficiaries. 

Although the study found that Medicaid and Medicaid beneficiaries often pay higher Medicaid and medical care bills, it also found that Florida Hospital was in compliance with Medicaid billing rules. 

At least half of all Medicaid beneficiaries who received care from a Medicaid provider received payments at a rate of less than $100 for at most three months in the past three years, and about one-third of those Medicaid beneficiaries did not receive any payments for at all in the same period.

In total, nearly 80 percent, or 2.9 million, of Medicaid and 693,000 of Medicare beneficiaries had no payments for more than three months. 

Cottrell said that as part of its new health plan, Florida will provide more information to Medicaid beneficiaries about the medical care they receive, including how much Medicaid and non-Medicaid beneficiaries are charged and how long it takes to receive care. 

While hospitals do not have to disclose the names of their Medicaid providers, they have a duty to provide beneficiaries with the right to review and request information about billing practices from hospitals, Cottrel said. 

Florida Hospital will also begin to publish a database of Medicaid providers and payment rates, and will start a process to identify hospitals that are not meeting those requirements.

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