Four key federal programs that impact Missouri health care providers and recipients remain unfunded as Congress is focused elsewhere.

A September 30th deadline to renew the services slipped by as lawmakers in Washington were aggressively pushing to overhaul the Affordable Care Act, an effort which ultimately failed.  Now, Congressional Republicans are trying to finalize major changes to the tax code, with the Senate vowing to vote on a plan this week.

Of the four health care programs hanging in the balance, three deal with reimbursements to hospitals.  They include funding for Medicare dependent and low volume hospitals, as well as money for medical centers that handle an especially large number of uninsured people who are unable to pay for care.

Providers are also concerned about renewal of coverage known as the Children’s Health Insurance Program, or CHIP.

Truman Medical Center in Kansas City, as a leading safety net hospital, delivers the highest percentage of uncompensated care in the state at 12%.  It relies on $14 million through Medicaid’s Disproportionate Care Hospital program to help cover those costs as 25% of its patients can’t afford to pay.

Truman Medical President and CEO Charlie Shields remains confident Missouri’s Congress members will help secure the needed funding.

“We have had great support, particularly from our Congressional delegation, not just our members on the House side, but also (Claire) McCaskill and (Roy) Blunt on the Senate side,” said Shields.  “And I think we’re headed in the right direction.  I know people are nervous, but we think this gets resolved before the end of the year.”

The Disproportionate Share Hospital (DSH) program dates to the Reagan administration in 1987.  The Affordable Care Act called for the program to be downsized under the assumption the expenses it covered would no longer exist after states expanded Medicaid coverage and participation in the health exchanges increased.

State such as Missouri that haven’t expanded Medicaid would take a major hit if DSH funding were to be discontinued.  Those cuts have been delayed numerous times by Congress, but there’s no framework to stop them now.

The two other currently unfunded federal services that reimburse hospitals are the Medicare Dependent and Low Volume Hospital programs.

Low Volume facilities treat small quantities of people that are highly dependent on Medicare.  Medicare Dependent Hospitals have a high volume of patients – more than 60% – who fall under the federal program.

Dave Dillon with the Missouri Hospital Association says the state has financing for these programs over the short term, but is hoping other states feeling the squeeze will speak out. “We’re holding out hope that, given the growing pressure from other states that are much closer to running out of funds, that Congress will take action,” said Dillon.

The fourth unfunded service in question is the Children’s Health Insurance Program (CHIP).

CHIP enjoys strong bipartisan support among lawmakers, and it’s thought that the other three programs in jeopardy could be bundled together with CHIP and renewed together.   In 2015, the Medicare Dependent or Low Volume programs were extended under such an arrangement.

CHIP was created by Congress in 1997 to provide health coverage for uninsured children in moderate – to low – income working families who are not eligible for Medicaid.

Dillon thinks the programs will get the attention they need once lawmakers in Washington finish dealing with taxes.  “It really comes to what agenda members of Congress want to move,” Dillon said.  “And right now, we’ve dealt most of this year with health care, and then now we’re moving to tax policy.  So, when those move out of the way, these issues will probably be fairly quickly resolved.”