Medicaid pay cut probably inevitable for primary care
- Most physicians expect Congress will once again deliver an 11th-hour legislative patch to override the 21% Medicare cut under the sustainable growth-rate formula (SGR). However, a 42.8% Medicaid pay cut that primary-care physicians face Jan. 1 is expected to stay.
- The ACA raised Medicaid fees for primary-care services to match Medicare reimbursement levels for 2013 and 2014, in order to help ensure new Medicaid enrollees had access to primary-care services. But that provision expires Dec. 31, and a bill to extend those payments has received little attention.
- A new Urban Institute report noted that the extra pay coincided with efforts to increase Medicaid enrollment, which the report said has grown by 7.5 million people since the third quarter of 2013.
Even with the extra parity payments, Medicaid is struggling. The influx of post-ACA Medicaid enrollees has highlighted widespread physician shortages, largely due to insurance-network consolidations and physicians dropping out of Medicaid.
A report from the Urban Institute noted that it is unclear how much impact the ACA provision has had on increasing healthcare access for Medicaid enrollees, though it cites one study that found "significant new provider participation in Medicaid due to the increase" in Connecticut, Modern Healthcare reported.
Though the consequences of halting the extra payments are unknown, as of Oct. 28, 15 states had indicated they would extend the parity payments with their own money. Still, medical associations aren't too optimistic.
"Medicaid's sudden return to disparate and inadequate payment for primary-care services will again shut out people who have come to know and depend on their primary-care physicians," said AAFP President Dr. Robert Wergin, in support of a bill that would prevent the Medicaid payment cuts.
- Modern Healthcare Medicaid pay cut looms for primary care docs