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Medicaid and Workers’ Comp

21 states have not (yet) chosen to expand Medicaid; one can (and I have) argued that this is nonsensical at best, as

  • the Feds are paying for ALL of the additional cost for another two plus years, and
  • the vast majority of the cost (90% +) thereafter; and
  • the savings to the states for uncompensated care would be anywhere from $4 to $9 billion;
  • health care providers in non-expansion states are in dire straits due in large part to the “non-expansion.”

My sense is the non-expansion states will eventually decide to accept the Medicaid deal as the financial cost to hospitals and health systems will force them to. And, the Feds will work with the states to create different models that will be ideologically palatable, providing cover to those politicians obsessed with such things.

But until – and unless – Texas, Florida, Virginia, Wisconsin and the rest expand Medicaid, there’s a raft of problems created by their principled if (in my view) wrong-headed position.

Mostly, these problems are due to two things.  Over the short term, the cost pressure placed on facilities and health systems and the fallout therefrom will lead to increased pressure to cost shift – and yep, work comp is a pretty soft target.

And long term, the 6.4 million adults who remain uninsured will be less healthy, have more incentive to get care under workers’ comp, and heal more slowly with more complications if they do get injured on the job.

What does this mean for you?

For work comp payers, nothing good.

4 thoughts on “Medicaid and Workers’ Comp”

  1. We already see too many injured workers who even with Medicaid,have delayed too long, been treated too little or fell through coverage gaps, for many personal health conditions that then adversely affect their treatment for work injuries. The best part of the expansion is the corresponding requirement that physicians and facilities are paid based on outcomes that will hopefully diminish those adverse effects over time.

  2. Steve was severely injured working for a manicipality, has been on workmans comp.
    They cancelled his health insurance.
    Has health issues that require regular medication
    and regular appointments.
    Workman’s comp is low income.
    Would he qualify for Temporary Misdissippi Medicaid until after recovering from injury?

    1. Steve – he may qualify, aotho Mississippi’s medicaid is pretty bad. qualification requires an extremely low income and may not be available for single males. He may qualify for Medicare if he is fully and permanently disabled.

  3. When I got injured in 1989 the carrier applied for the Special Disability Trust Fund because of a 1973 forklift crushing my left femur resulting in shorting of leg and loss of rotation and extension of L- knee the doctors recommendations of over height shoe lifts led to inguinal surgeries being done under Medicaid I have been trying to get copies of this to do a Set-A-Side of the settlement because I was not at mmi at the time of settlement How do I go about getting this information

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Joe Paduda is the principal of Health Strategy Associates



A national consulting firm specializing in managed care for workers’ compensation, group health and auto, and health care cost containment. We serve insurers, employers and health care providers.



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