Medicaid Underpayment: A Tragedy Revisited

Medicaid Underpayment: A Tragedy Revisited

For the past two years, children have finally gotten equal access to care because pediatricians have been paid by Medicaid at respectable payment levels. While there were many struggles at the state level to implement the ACA mandate for Medicaid payments to be on par with Medicare payments, by the end of 2014, most participating practices experienced positive changes. Many practices opened their panels to accept more Medicaid patients. Most were able to use increased payments to improve services or implement the necessary infrastructure to accommodate increased Medicaid visits. Some innovative practices were able to expanded services offered to their patients. At the end of the day, more of the nation’s most vulnerable children had increased access to better healthcare. A recent published study in the New England Journal of Medicine summarizes these findings.

As of January 1, 2015, most states have reverted to their pre-ACA mandate payment schedules. The two year experiment was funded by the federal government. The hope was that states would see improved value in higher payment for primary care services and continue the parity payment with state funding. Most states claim their budgets are prohibiting them from even considering an extension. The AAP and professional partners have been advocating at the federal and state levels to extend the increased payment, but are meeting significant resistance.

What’s eye-opening to many advocates, is the disparity in payment between various state payment rates. Why is the public not outraged? Is the care of a child in Rhode Island worth less than the care of a child in North Dakota? The general public assumes that Medicare and Medicaid are two sides of the same coin. They don’t know that in some states a primary care doctor might be paid $70 by Medicare to see a 66 year old with a cold, but that same doctor would be paid $23.10 to see a 2 year old on Medicaid. Studies have demonstrated that decreased payment to primary care physicians by Medicaid correlates with inadequate access to care.[su_row][su_column size=”3/4″]Those low payment rates are not sustainable by practicing pediatricians. We care about the future of our country. We know that the future health of society depends on the health of our most vulnerable children. We must demand that our states place equal value on children as they do on the senior citizens. Grandparents want their grandchildren to receive high quality medical care. Good care requires adequate resources.

What can you do?

  • If you accept Medicaid, monitor your payment rates and make appropriate business decisions to manage the risk to your practice
  • Contact your AAP Chapter to join advocacy efforts
  • Use  AAP resources to find talking points and communication tools
  • Educate your patients, families and your communities about the issue
  • Use social media to get the word out!

Our patients and the future health of our country depend on everyone valuing our children.