Adding to the problem of late payments from Medicaid, a cut in reimbursements in December could cause further problems for U.S. Virgin Islands health care facilities, members of the V.I. Government Hospital and Health Facilities Corporation Territorial Board learned at the monthly meeting Wednesday.
Until the hurricanes of 2017 and pandemic in 2020 upset the economy, the federal program paid 55 percent of the bills incurred by Medicaid patients and the territory was responsible for 45 percent. According to board chair Christopher Finch, the hospitals traditionally have used the allotment from the V.I. government to cover their share.
After the 2017 hurricanes, Medicaid suspended the territory’s share and paid 100 percent of the medical bills for a period of time, then changed the percentage to 89.2 percent and now it is 83 percent. Due to the coronavirus pandemic, Medicaid began to rebate six percent back to the states and territories. However, on Dec. 3, the formula reverts to the original 55/45 and the six percent rebate will expire in March.
Health facility chief financial officers are participating in a series of training sessions provided by the V.I. Department of Human Services, which distributes Medicaid locally.
During the board meeting, Finch asked for comments from the two hospitals’ chief financial officers, Shenel Moorehead, acting CFO for the Juan F. Luis Hospital, and Pamela Gallagher, Schneider Regional Medical Center’s CFO. Both said reimbursements from Medicaid are chronically late and don’t even meet a 55 percent match.
Gallagher cited an example of Medicaid billing for the St. Thomas hospital and said SRMC submitted more than $11.5 million for reimbursement to Medicaid for the month of October.
“We do not get payments timely. The biggest issue here is the cash flow problem – erratic paychecks, if I only paid you this week and maybe not next week – it creates a lot of undue stress on the overall performance of the organization.”
Moorehead agreed with Gallagher about late reimbursements. She said the “per diem” amount of treatment is important to understand. Medicaid calculates it at the end of the year to determine the amount to be repaid to the hospitals “per diem.”
“The costs would go up if we bought everything we need, but we don’t because we don’t have the money,” Dr. Frank Odlum added.
In May, V.I. Delegate to Congress Stacey Plaskett introduced a bill to eliminate Medicaid funding limitations for U.S. territories in fiscal year 2022. It also would allow residents of the territories, unable to get health insurance through employers or health insurance exchanges, to obtain coverage that is at least as broad as the coverage available to members of Congress and their staff through the District of Columbia exchange.
Also, there’s a provision in President Joe Biden’s Build Back Better plan that eliminates the Medicaid split.
“If neither of those or something else isn’t acted on, we could go back to 55/45,” Finch said.
During the meeting, Daryl Smalls, vice president of Facilities Management and executive director of the Territorial Redevelopment Team, updated the board on rebuilding the Virgin Islands medical facilities, damaged in the 2017 hurricanes. He listed several requests for proposals awaiting action, including RFPs for soil assessments, project management for JFL and for professional help with JFL permits. He also talked about the importance of timely payments to vendors 24-48 hours after the organization receives the funds.
Administrators for both hospitals gave reports. Interim chief executive officer for the Luis Hospital Dyma Williams reported that the V.I. Cardiac Center will reopen after equipment has been replaced and public services have been obtained.
Williams also announced that 73 percent of the JFL staff has taken both COVID-19 vaccines and 82 percent has taken one shot. Due to the coronavirus regulations, there have been about 20 resignations or people who have gone from full- to part-time/per diem and 80 staff members have filed for exemptions due to religious or medical reasons.
Tina Comissiong, legal counsel, delivered the report for SRMC. She said 88 percent of the staff are vaccinated and 30 employees received the third dose. She didn’t specify if the 88 percent had taken both vaccines.
Comissiong also announced that cutting-edge technology has been installed in the operating rooms to allow tracking patient visits from consent to discharge and record and save patient data in one record.
The last several hours of the meeting were held in executive session to discuss financial and personnel matters. The next meeting will be on Dec. 1 virtually at 3:30 p.m.