Medical societies seek extension of Medicaid/Medicare parity

October 31, 2014

Reimbursing Medicaid at same rate as Medicare would help expand access to primary care, lawmakers told

Four leading medical societies are trying to persuade Congress to continue reimbursing primary care and immunization services provided under Medicaid at the same level as Medicare.

Representatives of the American Academy of Family Physicians (AAFP), American College of Physicians (ACP), American Osteopathic Association (AOA), and the American Academy of Pediatrics fanned out across Capitol Hill on October 27 to ask lawmakers to extend payment parity for at least two more years.

A provision of the Affordable Care Act includes funding for the federal government to pay for primary care and immunization services provided under Medicaid at rates equivalent to Medicare during calendar years 2013 and 2014.

A bill to extend payment parity for two more years was introduced in the U.S. Senate last summer by Sen. Sherrod Brown (D-Ohio). The legislation, known as the “Ensuring Access to Primary Care for Women & Children Act,” would expand parity payments to include obstetricians and gynecologists, certified nurse-midwives, nurse practitioners, and physician assistants.

The legislation has been referred to the Senate finance committee, but no hearings have been scheduled. A similar bill, the “Medicaid Parity Act of 2014” has been introduced in the House of Representatives by U.S. Rep, John Lewis (D-Georgia), but does not expand parity payments to the other categories of providers.

Read: More delays expected for Medicaid parity reimbursements

“Without Congressional action to extend Medicaid parity with Medicare, primary care physicians will se an abrupt cut to Medicaid payments for the care they provide to low-income families,” AAFP president Robert Wergin, MD, FAAFP, said in a joint statement from the four societies. “This could wipe out the progress of ensuring that low-income Americans have access to primary medical care. We know from research that when Medicaid beneficiaries cannot find a physician who accepts new Medicaid patients, they face the same access problems as those who have no insurance.”

“We are speaking for our patients when we urge senators and representatives to do the right thing and see that current Medicaid payment rates for primary care and immunizations are maintained,” adds Wayne J. Riley, MD, MACP, president-elect of the ACP.

“Ensuring access to care form physicians to treat the needs of these patients (Medicaid beneficiaries) is vital to improving the public health of our citizens, and we believe Congress should extent this important payment parity policy to that end,” said Robert Juhasz, DO, president of the AOA.

About 65 million people obtain primary care services through Medicaid, and physicians providing those services would face reimbursement cuts of 41 cents on the dollar, according to the statement.

Read: What will Medicaid expansion mean to your practice?

Failure to pass the legislation would not spell the end of parity payments everywhere, however. A Kaiser Family Foundation survey of state Medicaid budgets found that 15 states plan to fully or partially continue parity in 2015 using their own funds, and 12 more are considering doing so. 

In an interview with Medical Economics, Wergin said he is “cautiously optimistic” that Congress will fund parity extension nationally. “They saw the importance of access to primary care, but the drawback was how to pay for it,” he said. Wergin said tentative estimates of costs for the extension range from $4 billion to $6 billion.

“Our groups remain hopeful and will continue to push,” adds Ray Quintero, vice president of government relations for the AOA.

Earlier this year the ACP surveyed members who had enrolled in the reimbursement parity program to find out how they would respond to the program’s end.  Forty-six percent of respondents said they would either accept fewer Medicaid patients next year or drop out of Medicaid entirely.

A spokesman for Senator Brown said that if the Senate does not vote on the bill during the lame duck session, “Senator Brown will reintroduce in 2015 and look for ways to move the legislation. The most obvious vehicle coming up is the Sustainable Growth Rate, which is set to expire at the end of March and must be addressed before then.” 

The four societies represent about 423,000 of the nation’s adult and family primary care physicians and pediatricians.