Maine Gov. Paul LePage, who has opposed Medicaid expansion, is earmarking almost $15 million in his proposed fiscal 2016-2017 budget (PDF) for additional Medicaid payments to primary-care physicians to make up for funds from a federal program that expired Dec. 31.
Without the proposed state funds, Maine primary-care physicians would receive the equivalent of about 67 cents on every dollar that Medicare pays for the same services from Medicaid.
The Patient Protection and Affordable Care Act includes a provision boosting state Medicaid payment to match Medicare rates for 2013 and 2014. Congress allowed the provision to expire despite heavy lobbying from physician associations and an Urban Institute report detailing how primary-care physicians will experience an average 42.8% cut in Medicaid compensation as a result.
Maine joins a handful of states that have sought to continue to fund Medicaid primary-care parity.
LePage, a tea party favorite, is proposing a two-year budget that includes $7.45 million for Medicaid parity in fiscal 2016 and $7.41 million in fiscal 2017. He also is proposing to spend almost $13.5 million to support per-member, per-month payments to support health homes, the MaineCare version of patient-centered medical home practices.
LePage's support for Medicaid payment parity is a “pleasant surprise,” though disappointment remains regarding his decision not to expand Medicaid, said Dr. Dan Morgenstern, director of public policy for the Maine chapter of the American College of Physicians. Funding for the parity-provision still must get legislative approval before becoming a reality for Maine's doctors.
“I think it's partly a response to the strong lobbying that went on this past year to expand Medicaid—which didn't happen,” Morgenstern said of LePage's proposed parity bump.
Dr. William Sturrock, president-elect of the Maine Academy of Family Physicians, agreed.
“We are pleased with the decision to maintain parity—we don't know how long it will last,” Sturrock said.
Most practices were using the extra payment the past two years to help pay for transforming their practices into patient-centered medical homes, or to hire extra personal such as nurse case managers or mental health professionals, Sturrock said.
Dr. Lisa Letourneau, executive director of the Maine Quality Counts advocacy group for healthcare improvement, said about 200 primary-care practices in Maine are participating in federal demonstration projects such as the Multi-Payer Advanced Primary Care Practice program. The rest of the state's primary-care practices are struggling to get proper reimbursement from private plans as well as Medicare and Medicaid, she said.
“Interestingly, this administration has been consistently supportive of primary care, but primary care is dying on the vine in Maine. We really need Medicaid, Medicare, and all payers to come together and find a better way to support primary care.” Letourneau said.
Gordon Smith, executive vice president for the 4,300-member Maine Medical Association, said, as a result of the Medicaid two-year pay bump, individual Maine practices received from “a few thousand to about $950,000.” Lawmakers need to know how much is at stake.
Government officials have put pressure on physicians to show that the pay increase made a difference, Smith said. Preliminary results of an MMA-member survey show that it did encourage practices to see new MaineCare enrollees.
Follow Andis Robeznieks on Twitter: @MHARobeznieks