Medicaid rates Archives - Safety-Net Association of Pennsylvania

ACA’s Medicaid Pay Bump Helped But Benefits Now Lost, Study Says

Health status and access to care improved for Medicaid patients when the Affordable Care Act mandated a temporary rate increase for physicians serving newly insured patients covered through that law’s Medicaid expansion.

But when the mandate for increased physician payments ended and state Medicaid programs reverted to their previous, lower payments, many of those benefits were lost.

Or so reports a new study from the National Bureau of Economic Research.

According to the study, even a $10 rate increase improved access to care enough to reduce by 13 percent Medicaid recipients’ complaints about not being about to find a doctor. Utilization also increased. The temporary Medicaid pay increase has even been credited with improving school attendance and reducing chronic absenteeism.

Despite the benefits of the temporary increase in Medicaid payments to physicians, most states returned to lower payments when the mandated ended, most of the gains resulting from the better pay for treating Medicaid patients disappeared, and the disparities between privately insured individuals and Medicaid patients returned to their pre-Affordable Care Act levels.

Researchers estimate that increasing Medicaid payments to physicians by an average of $26 a visit would eliminate disparities in access to care.

These findings are especially relevant to Pennsylvania safety-net hospitals because the communities they serve have so many more Medicaid patients than the typical American community.

Learn more from the National Bureau of Economic Resarch study “The Impacts of Physician Payments on Patient Access, Use, and Health” and from the Healthcare Dive report “Even $10 increase in Medicaid payments helps erase disparities in care access, study says.”

PA Safety Net Admin2019-07-24T06:00:47+00:00July 24th, 2019|Affordable Care Act|Comments Off

CMS to Examine How States Set Medicaid Managed Care Rates

The Centers for Medicare & Medicaid Services (CMS) is launching an initiative to explore how states set the rates they pay managed care organizations to serve Medicaid patients.
The initiative consists of two parts: first, CMS is examining the adequacy of the process states employ to set their rates – a process that affects the adequacy of the rates themselves; and second, it is drafting updated Medicaid managed care regulations.
Because Pennsylvania safety-net hospitals serve so many Medicaid patients, this effort could have a future impact on the payments they receive for serving these patients.
Learn more about this new undertaking in this Kaiser Health News report.

PA Safety Net Admin2014-05-29T06:00:25+00:00May 29th, 2014|Pennsylvania Medicaid policy|Comments Off

Primary Docs Can Get Medicaid Pay Raise

The Affordable Care Act calls for selected primary care providers to receive an increase in their Medicaid fees during calendar years 2013 and 2014.
The pay raise, which seeks to bring Medicaid fees to the same level as Medicare rates, is intended to induce more primary care providers to serve Medicaid patients in anticipation of the increase in Medicaid enrollment expected when the Affordable Care Act takes full effect.
Eligible providers must complete a form attesting to their eligibility for the pay raise and the Pennsylvania Department of Public Welfare has issued the form and instructions for completing it. Find both the form and the instructions here .

PA Safety Net Admin2013-06-27T06:00:15+00:00June 27th, 2013|Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy|Comments Off

States Can Cut Medicaid Payments, Administration Says

States are free to reduce payments to providers to keep down their Medicaid costs, the Obama administration has told a court considering a challenge to a 10 percent cut in provider payments by California’s Medicaid program.
The administration weighed in on this subject in a legal brief submitted in a court case that will decide whether California can reduce its Medicaid payments to providers.
If California’s defense of its Medicaid payment cuts proves successful, it could provide a blueprint for other states to reduce payments at a time when most states are preparing for a significant expansion of their Medicaid rolls. Many states are already concerned about the potential for rising Medicaid costs while others have opted out of Medicaid expansion or are still undecided, typically citing the potential for growing costs as the primary reason for their reluctance to expand their Medicaid programs as envisioned under the Affordable Care Act.
Any movement toward reducing Medicaid payments to providers would be extremely harmful to Pennsylvania’s safety-net hospitals, which already suffer from inadequate payments that fail to cover the cost of the care they provide to the state’s 2.1 million Medicaid recipients.
To learn more about the California case and its potential implications elsewhere, see this New York Times article .

PA Safety Net Admin2013-02-28T06:00:15+00:00February 28th, 2013|Pennsylvania Medicaid policy|Comments Off

Medicaid Primary Care Pay Raise Set; OB/GYNs, ER Docs Excluded

When the Affordable Care Act’s mandatory rate increase for primary care services provided to Medicaid patients takes effect on January 1, ob/gyns and emergency room physicians will not be among the beneficiaries of the temporary raise in pay.
Under a new regulation issued last week, only family doctors, internists, and pediatricians will receive the pay increase, which was established as a short-term (two years) incentive to attract more physicians to serve Medicaid patients in anticipation of the significant increase in enrollment expected when many states expand their Medicaid eligibility criteria in 2014.
When working under the supervision of eligible primary care physicians, nurse practitioners and physician assistants also will receive the enhanced Medicaid payments.
State Medicaid payments for primary medical care typically fall well below comparable Medicare rates. Under the reform law, Medicaid payments for such services will be raised to Medicare levels for two years, with the federal government footing the bill for the difference.
Because they serve so many Medicaid patients and the state’s outpatient fees are so much lower than those paid by Medicare, Pennsylvania’s safety-net hospitals and the primary care physicians they employ should benefit greatly from this new policy.
Read more about who will and won’t benefit from the primary care fee increase and how it will be implemented in this Kaiser Health News article .

PA Safety Net Admin2012-11-05T06:00:03+00:00November 5th, 2012|Health care reform, Pennsylvania Medicaid policy|Comments Off

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