If you’re someone whose income falls below a certain level, you could be losing your right to choose your doctor these days.
Some of Michiana’s biggest health care providers, including Beacon Health System and South Bend Clinic, have recently stopped accepting new patients who rely on Medicaid for their health insurance.
It wasn’t clear exactly why Beacon and South Bend Clinic have made this decision. Officials with both health systems declined to be interviewed for this story.
In an email replying to WVPE’s interview request, South Bend Clinic spokesman George Jones said it would be “inaccurate” to report that South Bend Clinic has stopped taking new Medicaid patients.
But here’s how South Bend Clinic is greeting telephone callers these days: “If you have Medicaid coverage, we are only accepting patients with Medicaid who are already enrolled with one of our providers at this location,” the automated phone prompt says. “If you are not sure if you are enrolled, please hang up and contact your insurance.”
It was unclear how many patients Beacon has stopped seeing, or which, if any, of its services at Memorial or Elkhart General hospitals have been affected. Beacon also operates the E. Blair Warner Family Medicine clinic on South Michigan Street, across from Memorial Hospital, a critical primary care clinic for South Bend’s low-income population.
But WVPE has obtained a copy of a letter that a Beacon Medical Group patient in Middlebury received, informing them of a new Goshen Health doctor they’d been assigned to. The letter came from Managed Health Services, which contracts with the Indiana Medicaid program to manage care for Medicaid recipients.
The letter states, “Your doctor is no longer contracted with MHS.” It tells the patient the name and address of their new doctor but gives them no choices.
Earlier this year the Indiana General Assembly passed a bill, House Bill 1004, aimed at reigning in hospital care costs by requiring hospitals to be more transparent with their finances. The Indiana Hospital Association sharply opposed the bill.
As a concession to the hospitals, the bill also required the Indiana Family and Social Services Administration, the state agency that distributes federal Medicaid dollars, to compare its Medicaid reimbursement rates to those of other states and the national average. By early December the FSSA must submit an annual report with the comparison data to the General Assembly and to the new Health Care Cost Oversight Task Force created by the bill.
The hospital association told lawmakers that if they would increase Medicaid reimbursement rates, hospitals wouldn’t need to shift as many of their costs to patients with commercial or private employer-based insurance. The association said the state has a $500 million surplus, at a time when hospitals are still reeling from big revenue losses caused by the COVID-19 pandemic, when they had to stop non-emergency procedures. They’re also facing higher labor costs amid a nursing shortage.
But the bill that ultimately passed and was signed into law by Gov. Eric Holcomb didn’t increase Medicaid reimbursement rates for hospitals.
Brian Tabor is the Indiana Hospital Association president. He said the bill increased Medicaid reimbursement rates for dentists and physicians but not hospitals.
“Rates to hospitals have not been increased in 30 years and we really felt like that should be prioritized,” Tabor said, “in part because of the tremendous financial strain on hospitals across the state.”
Tabor said Indiana hospitals on average reported a 2% operating loss last year.
Nonprofit health care providers, such as Beacon, are exempt from paying most local, state and federal taxes. In return for that benefit, the IRS requires them to provide a concept loosely defined as “community benefit.” For example, under the Affordable Care Act, nonprofit care providers must provide charity care, where the provider agrees to eliminate what’s left of a bill, for low-income patients, after all insurance has been used.
Nonprofit hospitals must continue to serve Medicaid patients in the emergency room, Tabor said. Beyond that, he said it’s up to nonprofit hospital systems to decide how they provide community benefit.
“It’s a difficult time right now and that does lead to some difficult choices, especially in the short term. But the commitment that these institutions make are to be there for all patients over the long haul. Right now that is not an easy proposition.”
One care provider that is growing as a result of providers cutting off Medicaid patients is the nonprofit Healthlinc, which has 12 clinics around northern Indiana.
Healthlinc CEO Beth Wrobel said Healthlinc has received about 400 new Medicaid patients transferred from Beacon over the past four months. Although some patients might not be happy about being forced to leave a doctor they know and trust, the transition ultimately should be good for these patients because Healthlinc offers them a “one-stop shop,” Wrobel says.
“Think about the poor mom with two kids and if she has to bring a kid in for their school physical, and if she can see the dentist, get their eyes checked, if they’re having behavioral issues, see behavioral health, and in our Mishawaka clinic we have a pharmacy. If that can all be done in one stop, I don’t care who you are, I would rather do that.”
