AAFP Supports Senate Legislation to Extend Increased Medicaid Payments

Academy Also Applauds Move to Add Eligible OB/Gyns

August 04, 2014 03:16 pm News Staff

The AAFP has moved swiftly to support recently introduced legislation(www.murray.senate.gov) that would continue a program to boost payments for certain primary care services family physicians and other eligible clinicians provide to Medicaid beneficiaries.

[Doctor giving asthma treatment to young boy]

A provision of the Patient Protection and Affordable Care Act (ACA) increased Medicaid payments for certain primary care services provided by FPs and other primary care physicians to reach parity with Medicare payment rates, but the enhanced payment is set to expire at the end of 2014. On July 30, Sens. Patty Murray, D-Wash., and Sherrod Brown, D-Ohio, introduced S. 2694, which would extend the Medicaid payment hike for two more years.

"Extending and refining this enhanced payment will allow family physicians to continue to see current patients, and to add new Medicaid patients to their patient panels -- including those newly enrolled under the Medicaid expansion," said a July 30 letter(2 page PDF) from AAFP Board Chair Jeff Cain, M.D., of Denver, to the two senators.

Known as the Ensuring Access to Primary Care for Women & Children Act, the bill also would expand the enhanced payment to include OB/Gyns, a move the Academy itself has advocated in the past. "The AAFP supports the inclusion of physicians with a primary specialty designation of obstetrics and gynecology -- provided that they always meet the 60-percent primary care billing threshold," said the letter. "This recognizes that certain board-certified OB/Gyns can be classified as providing certain primary care services for women -- namely, those who engage principally in rendering such services in the ambulatory setting."

Story Highlights
  • Legislation introduced in the Senate and House would extend a program that enhances payment for certain primary care services family physicians and other primary care physicians provide for Medicaid beneficiaries.
  • The AAFP expressed strong support for the Senate bill in a letter to two senators who introduced the bill in that chamber.
  • Advocates for the legislation argue that historically low payment rates for Medicaid visits limit access to primary care for many patients.

In addition, the legislation, which is co-sponsored by Sens. John D. Rockefeller, D-W.Va., and Mary Landrieu, D-La., seeks to expand the payments to include other clinicians who care for women and children -- nurse-midwives, nurse practitioners and physician assistants -- because women comprise the majority of Medicaid enrollees. In 2009, nearly three-quarters of women enrolled in Medicaid were ages 18-44, and six out of 10 women in this age group reported seeing an OB/Gyn on a regular basis.

Finally, the Senate bill includes a provision that would increase payments for rural health clinics (RHCs) and federally qualified health centers (FQHCs) that are paid according to a physician fee schedule -- another move the Academy applauded. "The very essence of high-quality primary care is designed to encourage care in ambulatory settings and outside of high-cost settings like emergency rooms," said Cain. "Medicaid should not reward providers for performing certain primary care services in the (emergency department). Conversely, RHCs and FQHCs that bill Medicaid under the physician fee schedule should be entitled to the enhanced rate, since they do provide primary care services in the appropriate low-cost setting."

Medicaid covers an estimated 66 million people, but its payment rates are substantially lower than those of Medicare or private insurance. As a result, many physicians do not accept Medicaid patients or limit the number of new patients they will see.

A recent survey(www.acponline.org) conducted by the American College of Physicians revealed that nearly half of internal medicine physicians who participate in the current Medicaid payment parity program said they would reduce the number of Medicaid patients they see or drop out of the program entirely if it is allowed to expire at the end of 2014.

By increasing the payments, lawmakers hope to coax more physicians to treat Medicaid recipients and, thus, expand patient access to primary care.

The AAFP acknowledged in its letter that more time is required to determine whether the increased Medicaid reimbursement actually leads to improved access for low-income individuals.

"The AAFP applauds your leadership in seeing that this Medicaid to Medicare parity payment program be allowed to continue to allow for adequate evaluation," said Cain in the letter.

Meanwhile, on the House side, Rep. John Lewis, D-Ga., introduced a bill that would extend the payment for five years. Another House version sponsored by Reps. Frank Pallone, D-N.J., and Henry Waxman, D-Calif., seeks to include neurologists and psychiatrists in the enhanced payment program.

No cost estimate for a Medicaid payment increase extension has been released.

Six states and the District of Columbia have indicated they intend to use state finances to continue the Medicaid parity payment. Alaska and North Dakota were already paying physicians a higher rate for Medicaid before the ACA provision took effect in 2013. The remaining 42 states are set to allow their Medicaid payments return to the same levels from 2012, according to a recent report(capsules.kaiserhealthnews.org) from Kaiser Health News.

Related AAFP News Coverage
Ask the Expert
Is Medicaid Parity Achieving Goal of Boosting Primary Care Access?


More From AAFP
Medicaid-Medicare Parity