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Do hospital-based emergency Medicaid programs benefit trauma centers? A mixed-methods analysis.

Lisa Marie Knowlton1, Daniel S Logan, Katherine Arnow

  • 1From the Section of Trauma (L.M.K.), Surgical Critical Care and Acute Care Surgery, Stanford University; Stanford-Surgery Policy Improvement Research and Education Center (L.M.K., D.S.L., K.A., W.D.H., A.B.G., L.D.T., T.H.W., A.M.M.); and Department of Surgery (L.M.K., A.M.M.), Stanford University School of Medicine, Stanford, California.

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Hospital Presumptive Eligibility (HPE) increases Medicaid revenue and reduces uncompensated care for hospitals, especially trauma centers. This program improves patient access to care and hospital financial stability.

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Area of Science:

  • Health Services Research
  • Health Economics
  • Trauma Care

Background:

  • Hospital Presumptive Eligibility (HPE) offers temporary Medicaid coverage during hospitalization.
  • HPE can improve patient access to post-discharge resources and facilitate sustained Medicaid coverage.
  • The impact of HPE programs on trauma centers (TCs) remains less understood.

Purpose of the Study:

  • To examine the association between HPE participation and hospital Medicaid reimbursement.
  • To identify incentives driving HPE enrollment among general hospitals and TCs.
  • To hypothesize financial, operational, and mission-based incentives for HPE participation.

Main Methods:

  • Convergent mixed methods study including analysis of California's Annual Financial Disclosure Reports (2005-2021).
  • Thematic analysis of semistructured interviews with hospital stakeholders (n=8) to explore HPE participation incentives.
  • Primary outcome: Medicaid net revenue; secondary outcomes: uncompensated care costs.

Main Results:

  • 77.7% of analyzed California hospitals (285/367) participate in HPE, including 100% of TCs by early 2015.
  • HPE participation shows a significant positive association with net Medicaid revenue, particularly in Level I and II TCs.
  • HPE enrollment correlates with increased net patient Medicaid revenue (b=6.74, p<0.001) and decreased uncompensated care costs (b=-2.22, p<0.05), independent of ACA changes.
  • Stakeholder incentives include reduced hospital bad debt, enhanced patient satisfaction, and improved community access to care.

Conclusions:

  • HPE programs serve as a crucial pathway for long-term insurance coverage for trauma patients.
  • HPE participation contributes to the financial viability of trauma centers.
  • Streamlining HPE enrollment processes is recommended to reduce hospital burden and ensure patient engagement.