Over the coming weeks this blog will highlight a key feature of Medicaid and the individual states that administer Medicaid and CHIP leading up to the program’s 50th anniversary (July 30th). Hopefully, you’ll learn some interesting facts about Medicaid and each of the 51 state programs.
Basics: Washington Apple Health covers 1,696,515 lives
One small but mighty feature of the Affordable Care Act was a two year bump in primary care physician reimbursement within the Medicaid program. A perennial challenge with Medicaid is that lower reimbursements have constrained physician participation. Access to care has been a greater than usual concern with so many people joining Medicaid during the expansion. For two years, the federal government paid to supplement the rates of primary care physicians in Medicaid, raising their payment to parity with Medicare rates. (Speaking of using federal dollars to drive policy change…) At the end of the 2 years, states were free to maintain the higher rates through their own budgets (with standard federal match).
This study in the New England Journal of Medicine found that the reimbursement increases had the intended effect , increasing primary care appointment availability in proportion to the size of the fee increase (see graph). Washington is an expansion state, and Apple Health (what a name!) grappled with the expiration of the fee bump, which they were unable to maintain. In surveying their primary care docs, they found that three-quarters of doctors in small practices would restrict Medicaid patients after the expiration, and one-third would stop taking new Medicaid patients. Now that we are half way through 2015, we should start to see whether or not these concerns have come to pass. The real lesson from this experience is that higher reimbursement for Medicaid primary care providers is a way to increase access, and long-term solutions should be investigated.