December 19, 2014

Medicaid Providers Face Pay Cut for Primary Care Services

The Urban Institute, a nonpartisan think tank that researches and analyzes U.S. social and economic issues, recently released a report detailing the impending decrease in Medicaid physician fees. As the report explains, “because of long-standing concerns about the level of physician reimbursement in the Medicaid program and its effect on physicians’ willingness to accept Medicaid patients, the [Affordable Care Act included] a mandatory two-year increase in Medicaid fees for primary care services.”  That increase is set to expire in 2015. The federal government covered the full cost of the increase from January 1, 2013 through December 31, 2014.

The expected fee decrease for ACA primary care services in 2015 varies from state to state; Rhode Island physicians face the most dramatic drop (67.3%). Connecticut provider fees would drop 21.8% in 2015, but according to the report, Connecticut is among fifteen states currently planning to extend the fee increase through 2015. These states cover 15.6% of Medicaid enrollees, while the 23 states that do not plan to extend the increase cover 71.3% of enrollees. (Some states are still undecided.)

The report also notes that it is unclear if the fee increase has led to an increase in the number of providers who accept Medicaid.  According to a related Washington Post article, in Connecticut, the number of Medicaid primary care doctors increased by close to 900 in 2013 (from 2,370 in January 2013 to 3,256 in December).