One-third of Medicaid programs will extend primary care pay bump




WASHINGTON – One-third of the nation’s Medicaid programs say they will extend the primary care pay bump, whether or not the federal government continues to fund it, according to a survey conducted for the Kaiser Family Foundation and the National Association of State Medicaid Directors.

Medicaid programs from all 50 states and the District of Columbia responded to the survey.

Fifteen states said that they will continue Medicaid pay parity after it expires in December, even if the federal government decides not to. ©sndr/

Fifteen states said that they will continue Medicaid pay parity after it expires in December, even if the federal government decides not to.

Programs in 15 states – Alaska, Alabama, Colorado, Connecticut, Delaware, Hawaii, Iowa, Maryland, Maine, Michigan, Mississippi, Nebraska, Nevada, New Mexico, and South Carolina – said they will continue Medicaid pay parity, the higher reimbursement rate that was established by the Affordable Care Act, but which expires at the end of December.

The ACA required state Medicaid plans to pay primary care physicians (internists, family physicians, and pediatricians) at the Medicare rate. The federal government has covered the cost.

Programs in 22 states said they would not extend the higher reimbursement rate beyond this year; the remaining 14 programs said they had not made a decision, in part because they wanted to see whether the pay bump had increased physician participation in Medicaid, but also because they were waiting to see whether Congress would continue the higher reimbursement rate.

Darin Gordon, director of TennCare, Tennesse’s Medicaid program, said that his state was too financially strapped to extend the pay bump. “We’re not in a situation where we can sustain that without the continuation of that funding,” Mr. Gordon said at a briefing held by the Kaiser Family Foundation.

Kate McEvoy, Connecticut’s Medicaid director, said that the pay raise has been a great success in her state.

The “primary care rate increase was a tremendous precipitator of increased participation” by physicians in the program, said Ms. McEvoy. She said it had been an “enormously effective” policy that helped widen provider networks and increase access to care in the state.

Before the temporary rate bump, 1,622 primary care providers participated in Medicaid in Connecticut; that number had risen to 3,458 by the end of July 2014.

The expanded network of providers was crucial because the state elected to expand eligibility under the ACA, Ms. McEvoy said. At the end of 2013, there were 626,519 enrollees; as of August, there were 745,145, according to state figures.

The Connecticut Medicaid program decided to continue the Medicaid pay raise – at a less-than-100% level – for 2 years; it will now expire on June 30, 2016, the end of the state’s fiscal year.

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