Medicaid pay rates for doctors in many states traditionally have been extremely low – so low that most physicians didn’t want to participate in the program, or take on more Medicaid patients than they already had.
According to the Kaiser Family Foundation, Medicaid had paid only 59 percent of what Medicare did for primary care before that.
The Affordable Care Act raised the rates for primary care providers to be equal to Medicare pay. Medicaid had paid only 59 percent of what Medicare did for primary care before that, according to the Kaiser Family Foundation. The snag: the Medicaid “bump” lasted for only two years, until the end of 2014. And Congress has not renewed it, although there has been a bit of preliminary talk about it.
But as Michael Ollove reports for Stateline, 15 states have stepped in with their own funds to maintain part or all of the “bump.” That seems to have persuaded at least some doctors to continue being a Medicaid provider.
Ollove reports that when Indiana decided to spend about $40 million annually to keep its reimbursement rate high, 335 additional doctors began accepting Medicaid, along with 600 other providers, including nurse practitioners and physician assistants. “We’ve seen good results,” Joe Moser, director of Indiana Medicaid, told him. “We are interested in seeing if the results continue, and we have every reason to think that it will.”
The Stateline article describes how one Indiana physician has been affected:
David Schultz, a family physician who runs a clinic with a high percentage of Medicaid enrollees in southwestern Indiana, said low Medicaid reimbursement rates had made it increasingly difficult to maintain the practice.
“Frankly, we were losing money and losing personnel,” he said. “We had to increase the numbers of people we saw every day, stayed open much longer, worked through lunches, not taking half-days off.”
The higher rates haven’t changed his life enormously, he said, but the office has at least been able to cut back on the heavy scheduling.
In addition to Indiana, Colorado, Alabama, Iowa, Maryland, Mississippi and New Mexico are maintaining the full Medicare parity. Connecticut, Delaware, Hawaii and Maine, Michigan, Nebraska, Nevada, and South Carolina also committed to paying more than the old reimbursement rate, although not at the full “bump” level, according to a March report to Congress by the Medicaid and CHIP Payment and Access Commission (MACPAC).
States are using a variety of sources to pay the docs, including proceeds from cigarette taxes or tobacco settlement funds.
How much would maintaining the bump matter in improving access to care for Medicare patients? Many states will soon find out. In the 23 states that did not step in to continue the bump rate, primary care payments are expected to drop 47 percent. In 2012, before the pay increase, one out of three primary care doctors wasn’t accepting new Medicaid patients. That’s a much higher rate of decline than for Medicare or privately insured patients, Ollove writes.
How to do a story on this in your own state
Look at the national data from MACPAC, particularly this March report.
Check out this New England Journal of Medicine study – which does not include a definite assessment of how many more doctors were accepting Medicaid patients –on the impact of the reimbursement change.
State Medicaid directors should also have data on payment, participation rates, patient waiting lists, and some insight onto whether the policy is expanding health care access for low income people and connecting them to a regular source of care.
Talk to doctors (and NPs and PAs) in your community, and to state legislators. Do they take part in Medicaid? Did the “bump” encourage them to take part, or to increase the number of Medicaid patients they saw? Did they stop seeing those patients when the rate dropped (in those states), or decide to continue serving their current Medicaid patients but not accept new ones? How is Medicaid expansion (in states that are expanding) affecting this patient load picture? Are lawmakers considering a change? How will they pay for it?
State Medicaid directors should also have data on payment, participation rates, patient waiting lists, and some insight onto whether the policy is expanding health care access for low income people and connecting them to a regular source of care.
Related AHCJ Resources
Webinar: ACA changes on the way, CMS official says
Core Topic: Health Policy
Tip Sheet: Making sense – and stories – of Medicaid
