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District of Columbia: Barriers to Medicaid Enrollment Contribute to Hospital Uncompensated Care

HRD-93-28 Published: Dec 29, 1992. Publicly Released: Jan 28, 1993.
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Highlights

Pursuant to a congressional request, GAO reviewed the District of Columbia's (DC) Medicaid program and uncompensated hospital care in DC, focusing on the: (1) extent of DC hospitals' problems with uncompensated care; (2) Medicaid enrollment process and its relationship to Medicaid reimbursement and uncompensated care; and (3) potential barriers to enrollment in the DC Medicaid enrollment process.

Recommendations

Recommendations for Executive Action

Agency Affected Recommendation Status
District of Columbia The Mayor of the District of Columbia should establish a demonstration or pilot project focusing on the enrollment of Medicaid-eligible individuals at hospitals. Such a project could: (1) identify and describe the population or subpopulations of eligible patients having the most difficulty getting enrolled; (2) identify the assistance needs of these groups; and (3) test methods of providing these patients with needed assistance through outstationing of eligibility workers and other means.
Closed – Implemented
Two Medicaid eligibility workers are stationed at D.C. General Hospital to process Medicaid applications. A pilot project with eligibility workers at public health clinics was terminated after 13 months when it was determined that their caseload was insufficient to justify continuation. Hospital employees at all 7 disproportionate share hospitals in the District have been trained to prepare Medicaid applications and assist applicants. Completed applications are then forwarded to the District's central Medicaid eligibility unit for official approval. Salary and benefit costs for these employees has been determined to be an allowable administrative expense for the hospitals' Medicaid cost reporting purposes.

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Topics

Claims processingEligibility determinationsHealth care costsHealth insuranceHospital care servicesHospitalsLossesMedical expense claimsPublic assistance programsMedicaid