Hospital Care Assurance Program (HCAP)
A state and federal program administered by the Ohio Department of Medicaid, which provides funding to hospitals that have a disproportionately high share of uncompensated care costs for services to indigent and uninsured Ohioans. Part of the program offers Ohioans with family incomes at or below 100% of the current Federal Poverty Guidelines, and who are ineligible for Medicaid, help with unpaid hospital bills.
Tuesday, May 26, 2015: Ohio Medicaid Issues Letter to Hospitals for 2014 HCAP Assessment Process
While the Centers for Medicare and Medicaid Services (CMS) continue to review the proposed state plan amendment that will implement OHA-recommended changes to the distribution of Hospital Care Assurance Program (HCAP) funding for 2014, on Friday, May 22, the Ohio Department of Medicaid (ODM) distributed a letter (click here
) to Ohio hospitals regarding the HCAP assessment and payment process for the 2014 Program Year. In order to complete the assessment and payment cycles as quickly as possible, ODM has combined the preliminary and final assessment letter in their distribution. The preliminary assessment becomes the final assessment after fourteen days unless a hospital requests a reconsideration.
The first assessment is due on June 12, with payment to hospitals on or about June 22. The second assessment is scheduled for June 26, with payment to hospitals on or about July 8. However, this timeline is subject to change depending on the timing of CMS approving the state plan amendment. If approval is not granted prior to the first assessment due date, ODM will postpone collection of any assessments and release a new timeline. Though CMS technically has until the end of July to make its decision on approving the amendment, OHA is working to expedite their review process to allow for the distribution of funds according to the schedule released by ODM.
Audit Report on Ohio 2011 Medicaid DSH Program Released
The Ohio Department of Medicaid (ODM) has released a comprehensive report from its independent auditor, Myers and Stauffer (M&S), with findings from an audit of the FFY 2011 Ohio Medicaid Disproportionate Share Hospital (DSH) program, also known as the Hospital Care Assurance Program (HCAP). M&S reviewed ODM and hospital records from 2011 and checked hospitals’ compliance with federal program eligibility rules. Overall, the Ohio program fared well; the costs of care to the uninsured and Medicaid losses for most hospitals that year were well above the HCAP payment they received. However, a handful of acute care and specialty hospitals will be expected to refund some or all of their 2011 HCAP payments. OHA is awaiting details on how and when this will occur.
In addition, there is an issue involving several hospitals that self-reported they did not meet a federal requirement to provide non-emergency obstetrical services to Medicaid recipients in 2011, which has the potential to void their HCAP payment for that year. OHA expects details soon and will report again once the issue is resolved. ODM states the FFY 2012 statewide Medicaid DSH program audit will start in September. OHA is planning a webinar for members on Thursday, Sept 11. Additional information and meeting materials will be provided after Labor Day.
In 2014, Ohio hospitals anticipate receiving $374,022,296 in HCAP funding from the federal government in return for paying assessments totaling $220,030,862. The distribution formula will undergo significant changes in 2014 due to Medicaid expansion and the ability of federal DSH auditors to recoup overpayments from hospitals found to have received payments in excess of their hospital-specific DSH limit.
HCAP-Related Ohio Hospital Free Care Requirement
OAC 5160-2-07.17 requires that all hospitals write off bills for basic, medically necessary hospital level services to patients with family incomes at or below federal poverty limits, as defined by the rule.
OAC 5160-2-07.17 does not cover transplant services, physician charges, ambulance and patient convenience items (telephone, parking, television, personal items). In order for a patient’s care to qualify, (s)he must be an Ohio resident, not be covered by Medicaid recipient, and have a family income at or below the federal poverty line.
Each hospital has a policy for the review and approval of free care eligibility under the state rule. The patient should contact the hospital for an application. In some hospitals the patient will be required to provide proof of income (pay stubs or W-2s).
For more information, please visit our most recent Frequently Asked Questions
about HCAP/free care rules, eligibility and audit. If you are a hospital patient and have a question about the status of a pending HCAP application or need to request an application, please contact the hospital where you applied or would like to apply for the program.