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Study says Medicaid could cut county costs

The use of a team of specially trained social workers to expand Medicaid reimbursement for poor pregnant women could save more than $1-million a year for Hillsborough County and its greatest provider of indigent medical care, Tampa General Hospital. That conclusion is drawn from a six-month study recently completed by the hospital, the county, the University of South Florida and the state Department of Health and Rehabilitative Services.

The study projects that eight additional caseworkers could add more than 600 clients annually to the roster of pregnant women whose maternity costs are paid with Medicaid money.

The total savings to the county and the hospital is estimated to be $1,560 per client.

"With escalating costs for health care, this is the kind of program where success has been clearly demonstrated," Assistant County Administrator Pat Bean said. "We have an obligation to try to identify programs that will help stop that train that's rolling out of control _ that escalating cost."

Bean said she will take the results of the study to the Hillsborough County Commission as part of an overall proposal for meeting human-services needs in the county.

Medicaid is a public health program that uses federal, state and some local financing to help pay for medical care for the poor. Pregnant women are eligible for Medicaid if their income meets up to 150 percent of the federal poverty guidelines; for a family of four, that means the gross annual income could not exceed $17,475.

But Medicaid does not pick up the tab of every Medicaid-eligible woman who delivers a baby. First, she must provide the necessary documentation and be certified. Otherwise, the county's Department of Public Assistance pays much of the bill.

The six-month study of pregnant women seeking medical assistance at units of the Hillsborough Health Department used three caseworkers whose jobs were to complete documentation allowing Medicaid certification for clients.

"In some cases, they actually had to go out and locate a client, because many drop out of sight after the initial contact," Bean said. "Sometimes, it meant taking a client to get a record that might have been as simple as a birth certificate.

"It involves some hand-holding, but it goes beyond just being an advocate. It's whatever it takes to get the client certified."

In dollar amounts, the results were dramatic. Rates of certification rose from 63.8 percent to 76.2 percent. And more certified pregnant women means a greater savings of local financing earmarked for indigent care. The study projects that the use of eight caseworkers, with annual personnel costs of $24,000 each, would achieve these savings in one year:

$837,500 for the county's Department of Public Assistance, based on $500 per day for maternity stay at Tampa General for an average stay of two and a half days. If Medicaid was paying for those two and a half days, the county could spend the $500 a day elsewhere.

$318,250 for Tampa General, based on a higher reimbursement rate from Medicaid. The Department of Public Assistance pays $500 per day, but Medicaid's reimbursement to the hospital is $690, a savings of $190 a day per patient.

$101,976 for the county Health Department for neonatal care reimbursable from Medicaid.

The neonatal benefit points to an additional advantage highlighted by the study: healthier babies. Expectant mothers made several visits to Health Department offices for care after they learned Medicaid would pay the bill.

Preliminary data from the study group shows that, of 75 births to Medicaid-approved mothers at Tampa General, there was one full-term stillbirth, two newborns who stayed an additional day in the nursery and no other complications.

"Low birth-weight babies have medical problems that follow them all their lives," Bean said. "If you can promote regular care before delivery, there's an enormous savings for the community in preventing low birth-weight babies."

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