Tammy Barrie

Moab Regional Hospital (MRH) provides free or discounted care to many of the qualifying people that walk through its doors. But Jennifer Sadoff, the director of marketing and community relations at MRH believes that even more people could benefit if they knew that they qualify.

“It’s not like you have to be living in the depths of poverty to qualify for it,” Sadoff said. “We are a not-for-profit hospital. We have no stakeholders. Really our stakeholders are the community.”

For the last three years MRH has provided over 10-percent of the care and services that it offers to patients for free or at a discounted rate. And these numbers do not include the care that is covered by government programs like Medicaid or Medicare.

Approximately 85-percent of the $4,901,645 of charity care and bad debt that the hospital wrote off last year was for residents of Grand County, not visitors, Sadoff said.

One of the reasons that the amount of charity care that the hospital provides is so high is that the average income in Grand County is significantly lower than in the surrounding area.

Due to the scale and seasonality of Moab’s service industry, many of the town’s residents only make 60-70 percent of the region’s median income. This translates to the average annual salary in Grand County being around $12,000-$13,000 less than in surrounding counties, according to numbers released by the City of Moab.

“Our community has a really high percentage of people on Medicaid,” Sadoff said. “I think it’s a reflection of the economy. We are definitely seeing a big increase in bad debt.”

It is because of the high number of patients coming in with Medicaid that the hospital decided, this year, to invest in an in-house Medicaid eligibility worker, Tammy Barrie.

“It was definitely an investment in the hospital,” Sadoff said. “She’s right here in the hospital. She is a great resource.”

Barrie helps patients to work through and understand the Medicaid application. The idea is that, with this assistance, more patients will be able to qualify for Medicaid, and thus the hospital will not have to spend as much of its resources on charity.

A large amount of the charity the hospital provides goes to people who are denied Medicaid. And many of those people are denied not because they don’t qualify, but because they either do not fill the out the application correctly or because they do not get all their documentation in on time, said Clinda Lasater, the business office manager at MRH.

“Lets say someone comes into the ER and is uninsured. Immediately after their visit we give them a Medicaid application and our charity application,” she said. “We have the application in English and in Spanish. We have an interpreter that the hospital pays for.”

Part of the application is a financial evaluation, which also requires the patient’s most recent tax return and the last six months of pay stubs.

Once all of the paperwork has been received by Medicaid, a decision is usually made and received by the applicant within the month.

If Medicaid is denied, then the patient’s file will go to MRH’s four-person Charity Care Committee.

“Then they approve it or deny it,” said Riata Vigil, a business clerk at MRH.

That decision is based on a sliding fee schedule that is more generous than that of Medicaid, Lasater said.

For example, if an individual is making 100-percent of the federal poverty line, $958 a month, their entire medical bill is eligible for charity. If a patient makes 185-percent of the poverty line $1,771 a month then 50 percent of their bill is eligible.

Even an individual making 400-percent of the poverty line at $3,830 a month can get 5-percent of their medical bill paid for.

For a family of three making $19,530 or less, 100-percent of the medical bill is eligible for charitable coverage. If that family is making a combined $36,131 a year then 50-percent can be covered. And if that family of three is making $78,120 a year then 5-percent of the medical bill is eligible for free coverage.

However, income is not the only variable; the assets of the individual or family are assessed as well.

The Charity Care Committee meets twice a month to review patient files.

Those who have been unemployed long-term are also eligible to receive free or discounted medical service, so long as they get the appropriate paperwork from workforce services.

Charity assistance can also be applied for ahead of time if a patient is going in for an elective surgery for something like a hernia, said Michelle Corbin, accounts receivable at MRH.

“Anybody can apply,” Corbin said.

But because of the level of charity care provided at MRH, and the loss that the hospital sustains through Medicaid (which does not cover all the costs of many treatments, leaving the hospital to fill in the gap), MRH has not been able to put as much money towards the building’s mortgage as they would like.

The amount MRH currently owes on its mortgage is approximately $29 million.

In previous years the hospital has received Medicaid Disproportionate Share Hospital (DSH) Payments. DSH hospitals are hospitals that have a high number of patients on Medicaid. The DSH payments are designed to recoup the losses suffered by serving these patients.

Local governments or contributors are responsible for raising one third of the money. If that local money is raised, then the state will provide the other two thirds.

Last year the city and county provided the seed money. Grand County gave $195,000 and the City of Moab gave $82,000 for a total of $277,000, in order for the hospital to receive $876,800 DSH money.

But Sadoff said that it is unclear whether the city or county will provide the seed money this time around.

“We are going to ask the county for help,” she said. “We don’t know if they will be willing or able to help this year.”

MRH is also doing things like bringing in visiting physicians and holding fundraisers in an effort to bring in more money and find donors.

If the last few years have been any indication, then the amount of money that the hospital gives away in the form of free and discounted care will only continue to grow, Sadoff said. And since the MRH is a not-for-profit, private hospital, limiting the amount of charitable care they provide is not an option.

“Certainly it would be great to take that money and put it towards the mortgage, but that’s not an option. People need care,” she said. “Obviously we have to stay afloat but not at the expense of not helping people take care of their health.”