Politics continues to drive the
issue of financing Louisiana’s transition from state-run to state-overseen
hospital care for the indigent, leaving it uncertain whether the state will be
forced to pay back some money to the federal government.
The U.S. Department of Health and
Human Services finally
approved the state’s deals for the majority of its state-owned hospitals that
turn over management to nongovernment concerns. Through the first year of
operation by doing so the state has saved
$52 million and expanded
services. But HHS also alleged that part of the financing arrangement violated
regulations in that it relied upon front-loading lease payments by the
operators. It essence, it claimed that early delivery of these provided
additional money for the state to use to obtain reimbursement of Disproportionate
Share Hospital claims (the federal government typically pays about three-fifths
of these), to the tune of $190 million. Regulations forbid anything that is not
a payment for service, so if this interpretation were to be accepted, the state
would have to pay that back.
Logically speaking, HHS’s never has
been a convincing argument. A lease payment is a lease payment regardless of
its timing and does not turn into a “donation” just because it’s early. And it
makes perfect sense for these kinds of early payments as an inducement for the operators
to stay on the job; in fact, amendments forced upon the state in this review
process made it easier for operators to bail out earlier, magnifying the value
of this tactic. If an operator shows good faith to see through the length of
the contract by paying more of it up front, then it is likelier not to
terminate the contract early if it know its payments are going to go lower in
future years. Making all lease payments equal only encourages instability in
the program.