Medicaid Reimbursements Increasing for Primary Care Physicians

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Effective through 2014, Medicaid reimbursements for physicians providing primary care services will be increased to Medicare level. Through this mandate in Section 1201 of the Affordable Care Act, the payments given to physicians will increase, providing for Medicaid patients to receive better access to primary care.

A patient’s overall health can be dependent on many factors. Whether or not a patient receives regular medical care and has adequate healthcare coverage can both have a great influence. Unfortunately, many Medicaid patients have struggled with the low reimbursement rates. On average, Medicaid only reimburses about two-thirds of what’s paid by Medicare resulting in a lack of Medicaid patients receiving the attention they need.

While the program was widely supported, it took longer to complete than was expected. Although the new policy was implemented in 2013, the CMS regulations were not completed until the end of 2012, much later than had been originally predicted. Regrettably, this meant that the program was behind from the beginning.

The program also faced some technical challenges. The rates for Medicare fee-for-service had to be converted into Medicaid rates and the new amounts had to be calculated. This can be a very time consuming process. Medicaid organizations can also be comprised of very diverse providers. A Medicaid managed-care organization could consist of non-profit, for-profit, and Medicaid-only providers. It may also deal with different health insurance companies and the many plans they offer, making it difficult to streamline the process.

As 2013 came to a close, several organizations such as the American Academy of Family Physicians (AAFP), American Congress of Obstetricians and Gynecologists (ACOG), and the American College of Physicians (ACP) urged the U.S. government to extend these changes for another two years. Their argument is that the program was slow to start and that more time is needed to prove the effectiveness of the program’s changes.

Although there have been many obstacles and delays, the goal of the reimbursement policy remains the same. With the financial worry eased, primary care providers should be more willing to treat Medicaid patients and provide them with the healthcare they need.

Author: Apoorva Anupindi

One thought on “Medicaid Reimbursements Increasing for Primary Care Physicians

  1. It’s unfortunate that low reimbursement rates have such an effect on healthcare. A patient’s overall health should be the priority. Hopefully, with these changes in place, Medicaid patients will continue to have better access to the healthcare they need.

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