Safety-Net Providers in a Post-Reform World: Medicaid Matters Julia Paradise Associate Director Kaiser Commission on Medicaid and the Uninsured for Health Policy, Law, and Ethics Forum George Washington University School of Public Health and Health Services Wake Forest University School of Law and Center for Bioethics, Health and Society October 17, 2012

FIGURE 2 The majority of health center and public hospital patients are uninsured people and Medicaid beneficiaries SOURCE: Public hospital data from America’s Safety Net Hospitals and Health Systems 2010: Results of the Annual NAPH Hospital Characteristics Survey, National Association of Public Hospitals and Health Systems, May Health center data from 2010 UDS, HRSA. FIGURE 1

FIGURE 3 Medicaid is a major source of financing for safety-net providers Total = $47 billion SOURCE: Public hospital data from America’s Safety Net Hospitals and Health Systems 2010: Results of the Annual NAPH Hospital Characteristics Survey, National Association of Public Hospitals and Health Systems, May Health center data from 2010 Uniform Data System (UDS), HRSA. Total = $12.7 billion Public Hospital Net Revenues by Payer, 2010 Health Center Revenues by Source, 2010 FIGURE 2

FIGURE 4 Key Medicaid decisions will affect what safety-net providers can achieve under health reform Implementation of Medicaid expansion? Scope of Medicaid benchmark benefits Medicaid outreach and enrollment effort Allocation, targeting of Medicaid DSH Adequacy of Medicaid provider payment rates SAFETY-NET PROVIDERS FIGURE 3