Will Medicaid parity be extended?

The Affordable Care Act (ACA) provision to increase Medicaid reimbursement to primary care physicians is set to end on December 31. Unless Congress acts to extend so-calledMedicaid parity, primary care physicians (PCPs) will face a new year with reimbursement decreases, which many experts fear will halt the progress made by the ACA to provide greater access to healthcare.

One of the methods by which the ACA attempts to reduce the number of uninsured Americans is by expanding access to Medicaid coverage, something  27 states have agreed to do thus far. Between September 2013 and April 2014, Medicaid enrollment increased nationwide—even in states that chose not to expand their programs—by more than 10%.

To ensure a sufficient level of provider participation and patient access to medical services, the law included a two-year provision that increased Medicaid primary care reimbursement rates to the same level as Medicare for physicians who are board-certified in family, general internal or pediatric medicine. Under the Medicaid Parity provision of the ACA, providers are paid on par with Medicare rates for 2013 and 2014 for a defined set of primary care-related services. The increase is funded entirely by the federal government.

Prior to the rate increase, Medicaid programs paid, on average, 66% of Medicare rates for all services, and just 58% of Medicare rates for primary care services, according to a Kaiser Family Foundation report on Medicaid and the uninsured.