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State officials request another Medicaid waiver extension

Despite more than six months of negotiations, state officials and the Obama administration still don’t see eye to eye on federal funding for the state’s safety-net hospitals, which care for many of the remaining uninsured patients in Massachusetts.

This week, Massachusetts Health and Human Services Secretary Dr. JudyAnn Bigby requested another extension of the state’s so-called Medicaid waiver -- until Dec. 31 -- to give the two sides more time to negotiate a new agreement.

The waiver is crucial to the success of the state’s mandatory health insurance law, as it authorizes federal funding for Medicaid and subsidized insurance coverage for the poor, and for hospitals serving the uninsured.

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Health and Human Services spokeswoman Jennifer Kritz said she could not comment about the sticking points.

But according to members of the Massachusetts congressional delegation and others who follow the discussions, there is a divide over how much federal money should go to Boston Medical Center and Cambridge Health Alliance, the two hospitals that treat the most poor patients in the state.

According to the three-year waiver that expired in June (the state has gotten numerous extensions already), funding for the hospitals to treat the uninsured was supposed to be temporary, as more patients became insured under the new law. Both hospitals are struggling financially.

“The plan was to phase out those payments,’’ said Brian Rosman, research director at Health Care for All, a Boston-based consumer group. “One question is how fast?’’

Congress is looking to trim trillions from the federal budget. But Massachusetts senators and representatives requested that the Centers for Medicare & Medicaid Services keep the funding for Massachusetts safety-net hospitals at $4.6 billion because any reduction, they said in a recent letter, would “impede Massachusetts’ landmark health reform” and imperil payments to doctors and hospitals caring for low-income patients.

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One concerning development for Massachusetts is the resignation of Dr. Donald Berwick, the Medicare chief, who leaves the job this week. Berwick, a pediatrician, is a Harvard professor and has spent most of his career in the Boston area.

“He was seen as an advocate for Massachusetts,’’ Rosman said.


Liz Kowalczyk can be reached at kowalczyk@globe.com.