Primary care Medicaid payment boost could be delayed until December in some states

August 12, 2013

2013 is already halfway over, and primary care physicians in many states have yet to receive increased Medicaid reimbursements that were supposed to take effect on Jan. 1 of this year. Now, it appears that some states won't begin getting those larger Medicaid payments to physicians until December.

2013 is already halfway over, and primary care physicians in many states have yet to receive increased Medicaid reimbursements that were supposed to take effect on Jan. 1 of this year.

Now, it appears that 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 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 approximately 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 begin accepting new Medicaid patients, many of whom 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.

Primary care physicians 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. For that reason, it's too early to know whether the Medicaid payment bump will have its desired effect.

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;

  • 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.

 

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