WASHINGTON — A temporary bump in Medicaid fees paid to primary care doctors, an Affordable Care Act provision intended to get more physicians to accept Medicaid patients, will expire at the end of this month. Congress did not extend the higher rates, so unless states take action themselves or the new Congress revisits the issue, primary care doctors in Medicaid will see their fees fall by an average of nearly 43 percent starting in January, according to a new report from the Urban Institute.
Whether the expiration of the fee increase will make a difference in physician participation in Medicaid is unknown. That is because there hasn’t been enough time to analyze whether the hike actually convinced primary care doctors to take Medicaid patients.
“It’s expiring before it’s been evaluated,” said Sandra Decker, a researcher at the National Center for Health Statistics, an arm of the Centers for Disease Control and Prevention. Decker, who has published widely on the Medicaid physician workforce, said she will analyze the impact of the fee increase, but doubts her results will be complete before the end of next year.
Still, she noted, past evidence indicates that Medicaid pay increases spur participation by physicians. She predicted that the lower fees will make it harder for Medicaid patients to find doctors willing to see them or that they will have to endure long waits to see doctors who accept Medicaid patients.
A recent report by the Office of the Inspector General in the U.S. Department of Health and Human Services underlined the difficulty Medicaid patients already face in getting care. Federal inspectors found that more than half of the doctors identified by states as participating in Medicaid managed care plans could not schedule appointments because they weren’t at the listed address, were not participating in Medicaid or were not taking new patients.
Among providers who did offer appointments, more than a quarter of them had wait times of a month or longer. Daniel Levinson, inspector general for the Department of Health and Human Services, noted that one beneficiary who was eight-weeks pregnant had to wait longer than two months to see a Medicaid obstetrician.
“Such lengthy wait times,” Levinson said in the report, “could result in a pregnant enrollee receiving no prenatal care in the first trimester of pregnancy.”
Anticipating a shortage of primary care doctors in Medicaid, the ACA included a provision raising primary care physician rates to the same levels paid to primary care doctors in Medicare for two years. Although states and the federal government jointly pay Medicaid costs, the law required that the federal government pay for the raises. According to the Urban Institute report, as of last June, the fee increase had cost the federal government $5.6 billion.
Even as the provision went into effect, however, many heath economists doubted that it would have long-term impact on participation because the raise was temporary.
Matt Salo, executive director of the National Association of Medicaid Directors, said the fee bump also proved complicated for states to implement. The law was geared toward the traditional Medicaid fee-for-service model, but most of Medicaid now operates in a managed care system, in which doctors are paid a salary.