Noteworthy News

Implementation of Reform Act’s Medicaid Doc Pay Raise Uncertain

With the Affordable Care Act-mandated increase in Medicaid payments to primary care physicians now just a little more than two months away from taking effect, much remains unknown about how the increase will be implemented.

Under the 2010 reform law, payments to Medicaid primary care physicians will be increased to the same level as comparable Medicare payments, with the federal government picking up the entire $11 billion tab.

At this point, however, there are no regulations delineating how the increase will be achieved, leaving unanswered a number of questions, including what the new rates will be; how and when they will be paid; which physicians will receive them; and how physicians caring for Medicaid patients through managed care plans will receive their enhanced payments.

The purpose of the temporary, two-year increase is to attract more physicians to the care of Medicaid patients in time for the increased Medicaid eligibility that begins under the reform law in 2014.

Many physicians serving urban communities, and those employed by urban safety-net hospitals, are expected to  benefit from this pay increase.  Currently, primary care physician payments average 61 percent of comparable Medicare payments nation-wide.  Among more urban states, Medicaid payments amount to just 51 percent of comparable Medicare payments in New York, 43 percent in California, 56 percent in Pennsylvania, 70 percent in Massachusetts, 62 percent in Texas, 53 percent in Illinois, 51 percent in Michigan, 50 percent in New Jersey, and 60 percent in Ohio.

Learn more about the challenges of implementing this primary care physician Medicaid pay raise in this Kaiser Health News articleStock Photo.

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