A new online tool created by the Guttmacher Institute will help safety-net health centers that provide family planning services assess their financial sustainability in an evolving U.S. health care system. Specifically, it will enable centers to estimate the extent to which they are maximizing reimbursement from Medicaid and private insurance. The Guttmacher Institute’s Financial Sustainability Calculator for Safety-Net Family Planning Centers is designed to help these centers estimate two key indicators of their financial sustainability:
- the percent of contraceptive visits that receive reimbursement from Medicaid or private insurance, and
- the percent of the total cost of providing contraceptive visits that is recovered from Medicaid or private insurance.
With this calculator, users can do the following:
- generate estimates for different types of health centers (using Guttmacher Institute data);
- compare estimates for different types of health centers;
- input data from their own health center(s) to see estimates for their program;
- compare estimates for their own health center(s) with those for others; and
- estimate the potential impact that changing key inputs could have on sustainability.
They can also view charts with additional details about their results.
"We hope this easy-to-use tool will be of great value to safety-net health centers providing family planning services," says Adam Sonfield, senior policy manager at Guttmacher. "It will clearly demonstrate the benefit to providers of assisting their clients to enroll in coverage, securing contracts with health plans and doggedly pursuing plan reimbursement. Together, these moves can improve providers’ financial sustainability, enabling them to maintain services for those in their community who continue to lack insurance coverage."
The calculator can also show the value of expanding eligibility for affordable insurance coverage.
For example, using the built-in data, the calculator estimates that if a state that has not expanded Medicaid eligibility were to do so (by implementing the Affordable Care Act’s broad expansion of Medicaid as well as a more focused Medicaid family planning expansion), the proportion of providers’ costs recovered from insurance would jump, on average, from 23% to 33%. In other words, if advocates helped expand Medicaid eligibility in their state, they could not only help hundreds of thousands of low-income individuals receive needed coverage and care, but also dramatically improve safety-net centers’ financial sustainability.
This product was supported by the Office of Population Affairs, U.S. Department of Health and Human Services, under grant FPRPA006060. Additional support was provided by the Guttmacher Center for Population Research Innovation and Dissemination, under National Institutes of Health grant 5 R24 HD074034. The views expressed are those of the authors and do not necessarily reflect the official policies or positions of the funders.