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June 30, 2020

$15 Billion Is Being Distributed to Medicaid Providers by HHS. Has Your Practice Received its Share?

The federal CARES Act appropriated $175 billion to physicians, providers, and health care facilities through a variety of mechanisms. The most recent distribution that was announced by the Department of Health and Human Services is $15 billion dedicated for eligible physicians and providers who participate in Medicaid and the Children's Health Insurance Program.

To be eligible for this funding, clinicians must have billed their state's Medicaid/CHIP programs or Medicaid managed care plans between Jan. 1, 2018, and Dec. 31, 2019. Additionally, they must not have received payments from the earlier $50 billion Provider Relief Fund general distribution based on Medicare utilization.

Washington state's Medicaid agency, the Health Care Authority, has raised concerns with HHS about the Medicaid distribution, asserting the funds allotted are insufficient and that it's administratively burdensome for practices to tap into. Perhaps most concerningly, practices were not aware that accepting the Medicare general distribution would preclude them from receiving Medicaid funds, where the latter may have been financially advantageous for a practice. Further, there is no mechanism for a practice to return the Medicare funds to create eligibility for the Medicaid distribution.

If you believe you're eligible for a payment under the Medicaid distribution, HHS provides an Enhanced Provider Relief Fund Payment Portal that allows you to report your annual patient revenue, as well as information such as the number of Medicaid patients you serve, which will be used as factors in determining your payment. Distributions to eligible providers will equal to at least 2% of reported gross revenues from patient care.

If you have concerns pertaining to the Medicaid distribution or anything related to the Provider Relief Fund under the CARES Act, the WSMA wants to know. Share your perspective with us by emailing policy@wsma.org.

Find more information on financial relief measures for physicians and practices in our COVID-19 Resources webpages.

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