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Coverage and Delivery Reform

Medicaid, administered by states and jointly funded by states and the federal government, is the largest health insurance program in the United States, providing coverage to nearly one-in-four Americans – more than 72 million beneficiaries. As part of their missions, AAMC-member teaching hospitals and their physician faculty care for a disproportionate number of these patients, despite low Medicaid reimbursement rates. While representing 5% of the nation’s hospitals, major teaching hospitals account for 25% of all Medicaid hospital care and provide 31% of all charity care. Medicaid disproportionate share hospital (DSH) payments help alleviate some of this burden, but this funding is at risk. Unless Congress acts, Medicaid DSH funding will be cut by $4 billion in FY 2020 and increase to $8 billion per year between FY 2021-2025. Cuts of this magnitude would devastate the health care safety net.

Medicaid also plays a critical role in funding graduate medical education (GME). Though not mandatory, 42 states and Washington, DC, currently contribute to Medicaid GME to help offset the higher costs associated with training residents in teaching hospitals. This funding allows more physicians to be trained in teaching institutions, which improves not only the number of physicians, but also cultural competence, coordination between health care and community organizations, and access for Medicaid beneficiaries. Due to state budget shortfalls and Medicaid managed care organizations, there are serious concerns that less Medicaid funds will be available to train future physicians.

News and Updates

AAMC Submits Comment Letter on Proposed Public Charge Rule

December 14, 2018

The AAMC Dec. 11 submitted a comment letter to the Department of Homeland Security (DHS) on its proposed rule, “Inadmissibility on Public Charge Grounds.” The letter urges DHS not to finalize the proposal and to defer to the Department of State’s public charge determinations instead.

House Passes Medicaid Package

December 13, 2018

The House of Representatives Dec. 11 passed, 400-11, the Improving Medicaid Programs and Opportunities for Eligible Beneficiaries Act (IMPROVE Act, H.R. 7217). The package is comprised of several bills, including the Advancing Care for Exceptional Kids Act (ACE Kids, H.R. 3325).

Democratic Leaders Request More Information on Guidance for 1332 Waivers

December 7, 2018

House Energy and Commerce and Ways and Means Ranking Members Frank Pallone (D-N.J.) and Richard Neal (D-Mass.) sent a joint letter Nov. 29 to top Trump administration officials expressing concern and requesting more information about the proposed changes to Section 1332 waivers.

AAMC Submits Comments to CMS on Hospital Outcome Measurement for Patients with Social Risk Factors

November 30, 2018

The AAMC Nov. 29 submitted comments to the Centers for Medicare and Medicaid Services (CMS) in response to the agency’s request for information regarding Hospital Outcome Measurement for Patients with Social Risk Factors. 

AAMC Submits Comment Letter on Medicare Conditions of Participation Proposed Rule

November 30, 2018

The AAMC Nov. 19 submitted a comment letter in response to the Centers for Medicare and Medicaid Services (CMS) proposed rule to change Conditions of Participation (CoP) requirements under Medicare and Medicaid. According to CMS, the proposals would reduce regulatory burden and improve quality of care. 

On Government Affairs

Testimony and Correspondence

External Resources