According to the CMS website, in 2010 there were over 66 million people enrolled in Medicaid, or 21.5% of our population. During that same year, over $383 billion (yes, billion with a "b") was spent on Medicaid services by both the states and federal government combined. Those figures are the latest available from CMS and they are almost three years old. As 2014 approaches, there will be more people covered through Medicaid services as the uninsured will have health coverage options. Hold onto your hats, ambulance providers and billing companies -- the impact on your operations will be enornous!

We need to monitor Medicaid trends closely during this year. Medicaid compliance continues to be a major focus of OIG enforcement actions  (https://oig.hhs.gov/fraud/enforcement/criminal/index.asp), see January 16th & 17th.  In addition to the compliance focus, a new federal rule was proposed on January 22nd whereby more cost-sharing was suggested for Medicaid recipients. In particular, Medicaid recipients could be required to share costs related to non-emergency ER visits. Now that's a concept that could potentially trickle down to ambulance providers.

But the biggest issue on our industry's Medicaid horizon is the concept of mobile healthcare or community paramedicine. The Medicaid population will grow and is vulnerable with unique needs. It makes good, common sense to meet some of their needs within the community itself (and the needs of other patients as well). But at what cost? And how will providers get paid? Without revenue to cover the costs of these services, the provision of these worthwhile services may be in jeporardy.

State ambulbance associations and innovative providers nationwide are trackling the challenge of how these services will be delivered, financed and/or reimbursed. Whether it's a forward-thinking payment arrangement between provider and commercial payer, or an effort to get an individual state Medicaid systems to recognize the need to reimburse "treatment without transport" services, there are many initiatives afoot to address these issues.

The combined stories of a growing Medicaid population, increased focus on Medicaid compliance and how ambulance services will cope with the accompanying revenue issues has just begun. Stay tuned for more developments!