More delays expected for Medicaid parity reimbursements

August 25, 2013

Many states are encountering problems in getting the higher Medicaid reimbursements to providers due to them under the Affordable Care Act.

For some providers, increased Medicaid reimbursements will be nearly 11 months late.

In fact, some states won’t begin getting those larger Medicaid payments to physicians until December, Matt Salo, executive director of the National Association of Medicaid Directors, told American Medical News recently.

As a provision of the Affordable Care Act (ACA), Medicaid reimbursements for primary care physicians (PCPs) would be boosted to the same levels of those paid by Medicare-but only in 2013 and 2014. Increases in Medicaid fees are expected to average about 73% but will vary by state, according to a study by the Kaiser Family Foundation Commission on Medicaid and the Uninsured.

The idea behind the temporary boost was to help persuade more physicians to accept Medicaid patients, many of who will obtain health insurance through the ACA’s Medicaid expansion. About 33% of primary care physicians didn’t accept new Medicaid patients in 2011 and 2012, according to a July study in Health Affairs.

PCPs in several states, including Florida, Massachusetts and Michigan have begun receiving the higher payments, but most have not, according to the National Association of Medicaid Directors.

Eligibility for the higher payments extends to primary care physicians working in fee-for-service as well as managed-care settings, and includes:

  • physicians who self-attest to being board-certified in the specialties of family medicine, general internal medicine, or pediatric medicine;

  • subspecialists related to the specialties as recognized by the American Board of Medical Specialties, the American Osteopathic Association, or the American Board of Physician Specialties, and can also self-attest that they are board-certified; and

  • physicians practicing family medicine, internal medicine, or pediatrics who self-attest that at least 60% of their Medicaid claims for the prior year were for the evaluation and management codes specified in the final regulation implementing the applicable section of the ACA.