Patients in Crisis would Suffer under House GOP Plan
Medicaid Hospital Presumptive Eligibility Program Saves Lives and Money

Blog post

By Cathy Senderling-McDonald & Jackie Bender

A patient arrives at an emergency room at a public hospital in the Central Valley. During the visit, she is also diagnosed with a brain tumor that requires highly specialized care available only at certain facilities in the state. However, she recently relocated to the area for a new job, and she does not yet have health insurance through her employer. Thanks to an option in the Affordable Care Act known as Hospital Presumptive Eligibility, this woman – and hundreds of thousands of Californians like her who seek care at participating hospitals each year – can receive immediate health care treatment and coverage while her eligibility is processed. The hospital offering the specialized care knows it will be paid for her care, and she will have the peace of mind that her care will be covered by this temporary insurance coverage.

Hundreds of thousands of patients like this woman, including families and individuals experiencing acute health crises all over the state, would suffer under the American Health Care Act (AHCA) that House Republicans are pushing to pass on Thursday. They seek to not only repeal major portions of the Affordable Care Act but also decimate the Medicaid program, including elimination of the hospital-based presumptive eligibility option described here. There is a lot on the line for Californians – from patients to providers to taxpayers – if AHCA is approved with these problematic provisions.

In California, Hospital Presumptive Eligibility has been an important pathway to provide health insurance coverage to patients, and a big factor in the state’s uninsured rate dropping to 7.1 percent. This program has allowed hospitals to temporarily enroll individuals into Medicaid (known as Medi-Cal in California) so they can immediately access the full array of Medi-Cal benefits. The program gives people who are in medical crisis with the peace of mind that they have insurance coverage. Hospital Presumptive Eligibility allows eligible individuals to remain on this temporary coverage until their Medi-Cal applications can be fully processed. In the short-term, this provides individuals with the immediate care they need, including access to necessary follow-up after they have been stabilized; in the long-term, people are better equipped to seek preventative care and avoid emergency room visits, lowering overall health costs for everyone. 

As part of their attack on the Medicaid program at large, the House Republican’s health bill specifically targets the Hospital Presumptive Eligibility program. This would be extremely harmful to patients, hospitals and other providers and taxpayers.

As those who represent California’s 21 public health care systems, which include county-affiliated systems and the five University of California academic medical centers, and the 58 county human service agencies, we know that Hospital Presumptive Eligibility has been a lifeline to patients and has proved cost-effective for providers, county and state agencies and taxpayers.

Even three years after the ACA was fully implemented in California, Hospital Presumptive Eligibility continues to be an important pathway for providing insurance coverage for patients. There will always be patients who move to a new area to pursue work opportunities or for other reasons and don’t immediately have health care coverage; individuals who suddenly lose a job along with their health care benefits; and other unforeseen circumstances that make continued access to Hospital Presumptive Eligibility vital in California. 

Cutting Hospital Presumptive Eligibility also means a cost shift to taxpayers, as these drastic cuts must be accounted for somewhere.  Such a cut would likely cause hospitals to have increased uncompensated care costs and could cause delays in patients seeking important follow-up care, resulting in potentially more acute illnesses due to foregone care. Existing funding for uncompensated care in California is capped, and historically has not covered all the uncompensated costs incurred. We urge Congress to maintain Hospital Presumptive Eligibility – a critical component of care in the Medicaid program.

What you can do:

  • To learn more about changes proposed to the Medicaid program and concerns with the American Health Care Act, read the letter sent by California County Associations opposing the act, and share it with your community partners and networks.
  • To voice your concern, call the Capitol switchboard TODAY at 1.866.426.2631 to be connected to your representative and share your concerns: Please oppose the AHCA. No one should lose health coverage or experience an increase in costs or reduction in coverage due to changes Congress or the Trump Administration enacts to the ACA and Medicaid program.
  •  Make your voice heard on social media using #Fight4OurHealth and #ProtectOurCare, and encourage family and friends to do the same.

- Cathy Senderling-McDonald & Jackie Bender

Cathy is is the Deputy Executive Director of CWDA. Jackie is the Vice President of Policy with the California Association of Public Hospitals and Health Systems.