"The only thing I do know for certain is the effective date is November 5th," Goel says. "We know what the legislative language says but we aren't sure what the state is interpreting, how they are going to apply it, or the contractual and regulatory policy."
Goel says it's difficult to assess how much higher Medicaid reimbursements might be for critical access hospitals, for example, because the existing reimbursement system "is very long and convoluted."
"The way we pay hospitals under the Medicaid program is through a bundled rate. So it varies based on case mix and a lot of other factors that go in the contracts," he says.
In addition, he says, the law creates two new statewide agencies for hospitals large and small to contend with and there is no way of knowing how another level of bureaucracy could affect administrative costs.