If Congress fails to act, primary care physicians across the country will see on average a 41% cut in their Medicaid payments for certain primary care services as an Affordable Care Act provision expires Dec. 31.
As a result, some physicians plan to limit the number of Medicaid patients they see, while others will drop out of the program, according to a report released Sept. 23 by the American College of Physicians.
The Medicaid Primary Care Pay Parity Program – part of the ACA – raises traditionally low Medicaid payments to the same level as Medicare payments for certain primary care services. The program was designed to run 2 years.
Dr. Robert M. Centor
Legislators have expressed interest in extending the higher payments. In July, Sen. Patty Murray (D-Wash.) and Sen. Sherrod Brown (D-Ohio) introduced the “Ensuring Access to Primary Care for Women & Children Act” (S. 2694). The bill would continue the Medicaid pay parity through 2016 and would increase the type of providers who are eligible for higher payments.
Under the new legislation, physicians in the specialties of family medicines, pediatrics, and internal medicine, as well as midlevel internal medicine and pediatric subspecialties such as gastroenterology, would continue to receive Medicare-level payments when they provide primary care and immunization services to Medicaid patients through 2016. The bill would extend eligibility for the payment increase for obstetricians and gynecologists, nurse midwives, nurse practitioners, and physician assistants.
But with the midterm elections just weeks away, Congress is in recess while lawmakers return to their districts to campaign. The next chance to pass legislation will come in mid-November during a lame-duck session of Congress.
Dr. Robert M. Centor, chair of the ACP’s Board of Regents, acknowledged that the timing will make it difficult to get legislation passed. But ACP plans to continue to work with lawmakers and congressional staff over the next several weeks because the consequences of inaction are high for both patients and physicians.
“Having the Medicaid pay parity has really helped Medicaid patients a great deal,” Dr. Centor said. “Our job is to make sure Congress understands that. If they understand that, I think we have a good chance.”
A survey conducted by the ACP in April shows that patient access could be affected if payments are cut. About 40% of 283 ACP members who responded to the survey and who had enrolled in the Pay Parity program said they would accept fewer Medicaid patients in 2015 if the cuts took effect. A small number – about 6% – said they would drop out of Medicaid completely next year if Congress does not act.
In the meantime, some states are taking action on their own to extend pay parity under Medicaid.
Six states (Alabama, Colorado, Iowa, Maryland, Mississippi, and New Mexico) are spending their own money to extend the Medicaid pay parity through 2015, according to the American Academy of Family Physicians. Connecticut is extending the pay bump through the end of June 2015 and Michigan will support Medicaid payments at 78% of Medicare rates.
But Dr. Centor said a state-by-state approach is complex and time consuming and that ACP wants to see action at the federal level.
mschneider@frontlinemedcom.com
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