Budget Would Change Medicare Reimbursement At Community Health Centers

Proposal Sets Rates Based On Inflation, Scope Of Services Provided

Brandy Shaul (CC-BY-SA)

Federal community health centers that provide care to underserved groups in the state would see a change in Medicaid reimbursement under the governor’s budget.

The centers are currently fully reimbursed for the cost to provide patient services under Medicaid. However, Wisconsin Department of Health Services Spokeswoman Stephanie Smiley said the budget would set a rate based on inflation and the scope of services provided.

Smiley said the current system isn’t an efficient or economic way to provide care.

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“Or to achieve positive health care outcomes for patients that would lead to using fewer services,” said Smiley, noting that full reimbursements would incentivize providers to see more patients.

Smiley said the state could see about $25 million in Medicaid savings over the next two years from the change.

The Wisconsin Primary Health Care Association represents 17 community health centers. Lisa Olson, the association’s policy director, said the savings are artificial because the rate hasn’t been updated.

“They don’t take into effect the additional cost of providing care in the last 15 years as health centers have added services in response to community need,” said Olson.

Smiley, however, said savings estimates are reasonable and rates may go up or down depending on the services each center provides.

The proposal does not apply to 11 tribal clinics that are reimbursed as federal community health centers.