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CMS Waiver Answers Safety Net's $64M Question

Philip Betbeze, for HealthLeaders Media, February 22, 2013

Unfortunately, the scheme is unlikely to survive past the end of December. That's because Ohio has decided to budget for the Medicaid expansion called for in the Patient Protection and Affordable Care Act, which would supplant the waiver program. But for hospitals and health systems similar to MetroHealth in the roughly half the states that have decided to let the federal government set up their exchange, such a waiver, if granted, might have a much longer shelf life.

Nevertheless, Corlett says the program is worth doing not only because it provides new funding for the uninsured, but because it allows MetroHealth to expand many working relationships with outside health providers that it will need as shared risk ramps up in coming years.

"We'll be financing care from providers outside MetroHealth," says Corlett. "So we will reimburse them because they're augmenting our primary care services."

MetroHealth Care Plus, which is how the new initiative will be branded to consumers and providers, is also providing a pharmacy benefit, which is a new expense.

"We will have to learn over time how significant that expense will be," Corlett says.

The program requires MetroHealth to become an insurer in fact, if not in name, because it effectively must finance care and take on risk for a population of up to 30,000 previously uninsured, who do not have to access care at MetroHealth, necessarily.

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