New MACPAC Study Evaluates Medicaid, Medicare Payments
Medicaid payments to hospitals are comparable to or even higher than Medicare payments.
Or at least they are once supplemental Medicaid payments are included.
So concludes a new study by the Medicaid and CHIP Payment and Access Commission, a non-partisan legislative branch agency that advises the states, Congress, and the administration on Medicaid and CHIP payment and access issues.
In what MACPAC bills as the “first-ever study to construct a state-level payment index to compare fee-for-service inpatient hospital payments across states and to benchmark Medicaid payments to other payers such as Medicare,” the study found that
- Across states, base Medicaid payment for inpatient services varies considerably, ranging from 49 percent to 169 percent of the national average. This variation is similar to the variation across states previously reported for physician fees.
- States are not consistently high or low payers across all inpatient services due to differences in their payment policies.
- Payment amounts for the same service can also vary within a state.
The MACPAC analysis also concluded that
- Overall, Medicaid payment is comparable or higher than Medicare.
- Specifically, the average Medicaid payment for 18 selected conditions was 6 percent higher than Medicare, and the average Medicaid payment for all but two of the conditions was higher than Medicare.
- The average Medicaid payment for these 18 services was higher than Medicare in 25 states and lower than Medicare in 22 states.
Learn more about what MACPAC found – and how Pennsylvania Medicaid payments stack up – in the new MACPAC report “Medicaid Hospital Payment: A Comparison across States and to Medicare,” which can be found here, on MACPAC’s web site.
Included in this edition are stories about:
Pennsylvania’s Medicaid program is moving toward greater use of value-based purchasing in its Medicaid behavioral health programs.
The process of determining Medicaid eligibility in Pennsylvania either begins or works its way through the state’s county assistance offices.
Among those steps are ensuring that only providers registered with the state’s Medicaid program can prescribe opioids and fill opioid prescriptions for Medicaid patients; monitoring the opioid-prescribing practices of participating Medicaid providers and taking actions when those practices are inappropriate; introducing new opioid prescribing guidelines; improving access to naloxone to fight opioid overdoses; expanding drug treatment programs; and more.
With policy-makers in Washington considering some changes, and possibly major changes, in the state/federal Medicaid partnership, the Health Affairs Blog has taken a look at some of the options those policy-makers might consider.
The Safety-Net Association of Pennsylvania has prepared a detailed review of those provisions. Officials of safety-net hospitals who would like to receive a copy of this memo may request one by using the “contact us” link on the upper right-hand corner of this screen.