Doctors not yet seeing promised higher Medicaid fees

April 5, 2013

Primary care physicians aren’t yet seeing the higher fees for treating Medicaid patients promised under the Affordable Care Act.

Primary care physicians (PCPs) aren’t yet seeing the higher fees for treating Medicaid patients promised under the Affordable Care Act (ACA).

A provision of the ACA provides federal dollars to raise Medicaid reimbursements to match those of Medicare beginning January 1 of this year and extending through 2014. But an article on the Web site Forbes.com reports that the higher fees are not yet arriving. The article quotes Matt Solo, executive director of the National Association of Medicaid Directors, as saying doctors may not begin seeing the increased payments until June 30.

A 2012 survey of state Medicaid physician fees commissioned by the Henry J. Kaiser Foundation found that Medicaid fees average 66% of Medicare fees and that the average increase PCPs will see is 73%, although actual rates vary widely between states.

The increased Medicaid fees were included in the ACA as a way to encourage PCPs to treat the additional patients who will receive Medicaid coverage. Many of those newly insured patients are expected to seek medical care from PCPs.

A spokesperson for the Center for Medicare and Medicaid Services (CMS) quoted in the Forbes.com article says that many states are still in the process of filing the paperwork, known as State Plan Amendments, needed for the federal funds to get to the states. States are also having to reprogram their claims processing systems to pay at the higher rate.

The CMS spokesperson says states have been notified that they must make all enhanced payments to eligible providers retroactive to January 1.