ACA and Population HPSAs

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Low-Income Population designations will now get more difficult to obtain now that the U.S. Supreme Court has upheld most of the 2010 Affordable Care Act (ACA).

Although Medicaid expansion is one of the lesser-discussed provisions in the ACA, increasing the individual eligibility ceiling from 100-percent of the Federal Poverty Level to 133-percent will mean doctors will treat more Medicaid patients.

At face value, more generous eligibility requirements are a boon to uninsured or underinsured individuals who might otherwise go without healthcare or medical coverage. Though if all else remains equal, the increase in the number of patients with Medicaid will narrow documented physician shortages in communities with a Health Professional Shortage Area (HPSA) designation.

The reason is arithmetic.

To obtain a HPSA designation, a community must be surveyed to gauge how much work area physicians are producing in full-time equivalents (FTEs). In Low-Income Population HPSA designations, where the focus is on the low-income population, FTEs from physicians are gauged on how many hours a physicians practices primary care multiplied by the percentage of the patients who are on Medicaid or Sliding Fee Scales. The more people who have Medicaid, the larger the percentage of total patients they will become — increasing the doctor FTEs reported and, ultimately, lessening the degree of shortage.

According to a 2010 report from the Kaiser Family Foundation, new Medicaid enrollments are expected to increase to 27.4-percent than they would without the ACA. Although the numbers are difficult to peg with absolute certainty, it’s safe to estimate that physician FTEs to low-income populations would increase by a similar amount.

Already “safe” Low-Income Population HPSAs would become less so and designations that were very close to the line for designation in years past, may not be eligible for benefits of a Low-Income HPSA, like Federal physician loan repayment and priority placement of a physician from the National Health Service Corps.

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