Short Takes On News & Events

Few Medicaid Docs Have Seen 2013 Pay Raise

By Phil Galewitz

July 16th, 2013, 6:03 AM

Most primary care doctors are still waiting for that Medicaid pay raise that was scheduled to begin in January under the Affordable Care Act, but a federal official says the government has now approved applications from 48 states to begin paying the higher rates.

A spokeswoman for the Centers for Medicare & Medicaid Services says with those approvals in hand, every state but California and Alaska is expected to implement the pay raise this summer. Under the law, Medicaid fees for primary care would be increased for two years to the same amount paid under Medicare. The change means an average 73 percent pay increase nationally, according to a 2012 study by the Kaiser Family Foundation (Kaiser Health News is an editorially independent program of the foundation.)

The two states not included in the federal approvals are Alaska and California. Alaska already paid the higher rates before the law was implemented. The Obama administration is still reviewing California’s application. California Medicaid officials say they hope to begin paying the higher amounts in September. The pay raise would be significant in California because its Medicaid reimbursements are among the lowest in the country.

Medicaid pay to doctors has been a point of dispute between California Medicaid officials and patient advocates for years. When the state reduced rates for doctors in 2008, advocates sued, saying the reimbursement was so low it would drive away providers and violate the Medicaid Act’s promise that poor patients would have access to quality care. The 9th Circuit Court of Appeals, based in San Francisco, blocked the cuts. But the Obama administration later approved the state’s request for the lower pay. The Supreme Court last year declined to rule on the case and sent it back to the 9th Circuit.

The two-year pay raise is intended to entice more doctors to treat the millions of residents expected to enroll in Medicaid in 2014 when the federal health law expands eligibility. Critics have said the expansion of the federal-state program for the poor would accelerate the shortage of doctors who treat them.

Matt Salo, executive director of the National Association of Medicaid Directors, said states are frustrated about the delay, particularly since the provision was designed to improve access for Medicaid recipients. “Its been slow to roll out … and it’ll be gone less than 18 months after it starts,” he said.

Part of the reason for the delay is the difficulty figuring out how to implement it, particularly since Medicare does not pay for some services – such as treatments related to children or to childbirth. Another obstacle, Salo said, was determining how Medicaid managed care firms could implement the raise when they pay doctors a monthly fee per patient, rather than for each claim made by the patient.

The Obama administration also did not issue the rules on Medicaid pay until last November, and state officials said they needed extra time to carry out the change and get federal approval of their new rates.

While Medicaid fees vary by state, they are generally far below those paid by Medicare and private plans.

CMS said that when states do implement the provision, doctors will be able to get the higher fees retroactively to Jan. 1. But many states set deadlines for April or May for doctors to self-attest that they are primary care physicians willing to accept Medicaid patients in order to get the retroactive pay. Those that missed the deadline will only receive the pay raise once they fill out a form showing they are licensed as a family doctor, pediatrician or internist.

7 Responses to “Few Medicaid Docs Have Seen 2013 Pay Raise”

  1. Ben says:

    Well, I live in Florida so it makes sense that Medicaid fees vary by states.

  2. My wife is in healthcare and it sounds like her mid-sized company is really freaking out about the Affordable Care Act. It will be really interesting to see what happens over the next several years.

    I can’t help but think that all the government intervention is going to make things much worse for the average american.

  3. Jack Kimple says:

    As a Primary Care Family Dr in California, I can tell you that the fee for a routine office visit with me pays $73 for a Medicare patient, and $22 for the same coded office visit for a MediCal patient. We waited with baited breath for the implementation of the “parity” clause of the ACA to go into effect in 1/13, as required by the law. Our group of 10 Primary Care providers recently decided to drop out of the MediCal program, since it such a low paid line of business vis-a vis MediCare or all other private insurers, including the new participants in the Covered California sponsored exchanges. This is not a political, but rather a hard headed business decision.

  4. wilson says:

    Anybody else sick and tired of hearing providers constantly whining and crying that they don’t get paid enough? If you don’t think you are getting paid enough, shut down you practice! It doesn’t matter what Medicaid pays, it will never be enough for these greedy shysters!

  5. Ronald says:

    I’m a mental health provider who lives in Texas and has felt the heavy boots of Gov. Perry and his cowboy colleagues. We have lost over 35% starting in 2010 and have incurred additional loses due to additional paperwork requirements of the Medicaid HMOs. I, too, had to drop out of the business, closing my practice which was the only one is 150 miles. Today the figures suggest that 90% of Texans have no access or inadequate access to mental health providers. Primary Care Physicians who have formed groups have no way of collaborating with a mental health provider with a 2 and 1/2 hour trip for their patients. Texas may have taken the hardest stand given Gov. Perry’s political ambition. The good side of coin is that this time has allowed me to finish my book about the affects of health care reform on those who are in private practice: Endangered Private Practice, Surviving Health Care Reform, Jason Aronson, August 2013. Advertised on Amazon.

  6. Norman says:

    Your first mistake? You practice in Texas! With 1 in 4 residents uninsured, why in the world would anyone want to be involved in the healthcare industry in Texas? With the way the governor and the state legislature discriminate against women’s healthcare, why would any doctor want to practice in Texas? The very last place a doctor should set up a practice is in Texas. Texas is still in the Cro Magnon era when it comes to healthcare. Stop whining about how lousy it is to practice medicine in Texas and leave as soon as humanly possible!

  7. Jane says:

    I am a primary care doc in Alabama. We started receiving the Medicaid raise on June 8. It has been awesome. Medicaid now pays more than Medicare for our office visits. We are a clinic that opened solely to care for Medicaid and Medicare patients and we did this when the fees were lower than now. It was plenty for us but of course we are thrilled with the increase.

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