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Primary-care docs to see increase in Medicaid rates


By Rich Daly
Posted: May 9, 2012 - 11:45 am ET
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(Story updated at 12:50 p.m. ET)

States will receive an $11 billion boost for primary-care physicians in their Medicaid programs over the next two years, under a new proposed rule (PDF).

The temporary increase in 2013 and 2014 is mandated by a provision of the 2010 federal healthcare overhaul and aims to bring Medicaid primary-care payments in line with the level provided by Medicare. The provision, released Wednesday, would increase average Medicaid primary care payments by 34%, according to one estimate cited by CMS.

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“Promoting high-quality primary-care is a pillar of the Affordable Care Act, and this proposed rule helps States and physicians provide every American, no matter where they live, access to the care they need to stay healthy,” HHS Secretary Kathleen Sebelius said in a news release (PDF). “This new rule can help improve health and reduce costs by preventing illnesses before they happen and catching small problems before they turn into big ones.”

Medicaid physicians eligible for the increased funding include family medicine, general internal medicine, pediatric and related subspecialists, according to HHS' news release. The increased payment requires no matching payments by states.

The increased payments aim to encourage primary-care physicians to provide checkups, preventive screenings and vaccines to Medicaid beneficiaries. The rule also acknowledges that federal officials hope the increased rate encourages more physicians to participate in the Medicaid program because more clinicians will be needed under the program's coming expansion. Other provisions of the Patient Protection and Affordable Care Act will begin expanding Medicaid's enrollment by at least 16 million in 2014.

“We're optimistic that this will help us attract and keep primary care doctors caring for Medicaid patients in our state,” Andy Allison, director of the Arkansas Division of Medical Services, said in a call with reporters.

Cindy Mann, director of the Center for Medicaid and CHIP Services at CMS, acknowledged in the call with reporters the limited efficacy of a temporary boost in physician reimbursements. Her agency plans to study the impact of the increased physician pay and “options” for continuing such benefits after the boost expires by 2015.


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