What's delaying the primary care Medicaid payment boost?

Primary care physicians (PCPs) should soon see their Medicaid reimbursements rise to the level of those paid by Medicare —if they haven’t already. The fee parity, funding for which was included in the Affordable Care Act (ACA), became effective January 1, 2013, and is scheduled to last through the end of 2014.

Increases in Medicaid fees are expected to average approximately 73%, according to a study by the Kaiser Family Foundation Commission on Medicaid and the Uninsured.

To qualify for the funds, however, states were required to amend their Medicaid plans. The deadline for submitting the amended plans to the Centers for Medicare and Medicaid Services (CMS) was April 30. CMS then had until July 1 to review and approve the amended plans. As of the third week of June CMS had approved 43 amended state plans. PCPs in Florida, Massachusetts, Michigan, and Nevada, were said to be receiving the higher payments, according to the National Association of Medicaid Directors.

An additional wrinkle is that about 60% of Medicaid patients nationwide are now in some form of managed care setting, and the ACA specifies that the payment increases must go directly to the provider. “So each state has to figure out a methodology for how to distribute the money, to crosswalk their capitated payments to their Resource-based Relative Value and Relative Value Units and apportion them appropriately,” explains Stuart Cohen, MD, MPH, chairperson for the California chapter of the American Academy of Pediatrics.