President's Message

Higher Medicaid Payments Take Effect as AAFP Efforts Pay Off

July 31, 2013 02:35 pm Jeff Cain, M.D.

Family physicians had more to celebrate in July this year than just Independence Day. As of July 19, Medicaid programs in 26 states had implemented a provision of the Patient Protection and Affordable Care Act that raises Medicaid payment rates for certain primary care services to at least Medicare levels for 2013 and 2014. Ten more states are expected to follow shortly, according to CMS.

Eight other states are expected to be on board by the end of summer, and all but two of the 49 participating states (California and West Virginia) have implementation dates scheduled before the end of the year.

The AAFP has been actively involved in this issue for more than three years. Nearly two-thirds of Academy members see Medicaid patients in their offices, but before implementation of the ACA provision, Medicaid averaged just 66 percent of Medicare rates for primary care services nationally. That inadequacy was a barrier to care for patients covered by Medicaid who were looking for a family doctor, and it was a burden to physicians who care for Medicaid patients.

With implementation of the Medicare-Medicaid parity provision, however, state Medicaid payment increases range from as low as 2 percent in Delaware to as high as 198 percent in Rhode Island. Twenty-six states will boost Medicaid payments for primary care services by more than 40 percent. Programs in Florida, Michigan and New York already have raised payments by more than 100 percent.

It's worth noting that payments to physicians practicing in managed care settings versus strict fee-for-service settings will see a greater delay in receiving the primary care increase because once state implementation plans are approved by CMS, states will have to work with managed care companies to include the increased rates. The bottom line, however, is that help is on the way.

The AAFP has worked diligently to help move implementation of the increased Medicaid rates forward. That effort started in 2010 with a joint letter from the Academy and other primary care stakeholders that urged members of Congress to include the parity provision in federal health care reform legislation. The Academy also provided input to the National Governors Association and the National Association of Medicaid Directors. More recently, the Academy and other stakeholders sent a May letter to CMS urging the agency to provide state-level information regarding the self-attestation process for parity payments.

Through this long process, the Academy has worked hard to keep members informed. AAFP News Now has published eight related news stories along the way to keep members up to date, and Academy staff members have created tools to help our chapters with state-specific instructions for members regarding the attestation process.

Speaking of attestation, the deadline for retroactive parity payments has passed in many -- but not all -- states. But it's not too late to qualify for increased Medicaid payments going forward. All state Medicaid programs have attestation information available online, but the forms aren't always easy to find. Contact your state chapter or state Medicaid program to avoid missing this opportunity because the increased payments will last at least through 2014.

Millions of Americans will be newly insured through next year's ACA expansion of Medicaid. Improving Medicaid payment rates is critical to ensure that these Americans will have access to primary care physicians. And keeping those increases in place beyond next year is a top priority for the AAFP.

Permanently improving payment for Medicaid services will improve access to primary care, which likely will lead to reduced reliance on avoidable emergency room services, improved preventive care, better quality and lower health care costs for our country. Even more importantly, it will lead to a healthier America, which, simply put, is the right thing to do.

Jeff Cain, M.D., is president of the AAFP.

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AAFP Checklist Helps Family Physicians Apply for Higher Medicaid Rate

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