Estle explains public health funding shortfall
Jefferson County Public Health director Chris Estle said she doesn’t have a clue about what the bottom-line might be when it comes to the projected public health budget shortfall for the current fiscal year.
“It could go either way over the next four months, but we are working diligently at being fiscally responsible,” she said.
Estle told the Jefferson County Board of Supervisors Monday that the shortfall didn’t appear to be $70,000, which is what she originally projected at the beginning of the county’s budgeting process.
By the end of February, the shortfall was only $18,700. However, Estle said that during the next four months, that number could change for better or worse.
“I have no idea what it’s going to look like,” she said.
What Estle does know is that since the privatization of Medicaid last April, the dynamics of health care have changed — which is one of the reasons for the more than $18,000 deficit.
Estle said another reason for the shortage is funding. Now, instead of one payer for Medicaid, which was the state of Iowa, providers have three third party payers to deal with.
Services for veteran affairs are also outsourced to a third party payer.
“The physical health care is hard, mental health care is hard and trying to coordinate the payment is exhausting and frustrating for the patient,” she said, adding that in addition to payment changes, other changes have occurred since Medicaid privatization.
“We’ve seen changes with providers, and with services that include home care, case management, pharmacy changes, and patient access to prescription medications,” she said.
“Initially there were problems with psychiatric injections where patients had delayed access to their medications. It could take two weeks for a patient to receive it. If you need an injection, you need to have access to that medication.”
Estle said prior to privatization, there wasn’t a need for pre-authorization for home care patient visits.
“Pretty much all of them request a pre-authorization now, which is an additional step,” she said, explaining that sometimes her home care staff couldn’t wait on a pre-authorization to treat a patient in need.
“Sometimes we go and see a patient and if authorization doesn’t go through, we are left without reimbursement, but the patient needed care,” she said. “That’s part of the reason for the shortfall.”
“Sometimes it’s difficult to talk to case managers on the phone, and we are dealing with nationwide payers, so there are certain things that they might not understand about our state,” she said, adding that the billing process is much more challenging for providers.
Estle said she’s even had challenges with VA’s third party payer Health Net.
“We were on hold to talk to customer service for three hours; we left the phone to do other things and came back. Customer service was still unable to help,” she said.
“I’ve been the public health administrator for nearly a decade, and I understand the process for which health care should be delivered,” she said. “The frustrating part for me is that our veterans deserve comprehensive health care delivered and paid for in an efficient manner, and they shouldn’t have to jump through numerous hoops in order to receive quality care.”
Estle said she recently reached out to Sen. Joni Ernst’s office about the challenges she has faced during the year.
“Her staffers said they were aware of the problems, and they were looking into it,” she said. “This is not a unique problem; it’s a greater issue that just our department.”
Estle said with the one year Medicaid privatization anniversary looming next month, she anticipates that there will be even more changes to face on the horizon for health care.