Enhanced Medicaid Managed-Care Pay Only Seen in Some States

Only 6 states across the country are currently receiving funds through the Affordable Care Act (ACA) provision intended to increase Medicaid managed-care payments to meet Medicare payment levels.

Only 6 states across the country are currently receiving funds through the Affordable Care Act (ACA) provision intended to increase Medicaid managed-care payments to meet Medicare payment levels. The American Academy of Family Physicians (AAFP) said the ACA provision will temporarily bring Medicaid payment rates for certain primary care services in line with Medicare levels for 2013 and 2014.

Lonnie Robinson, MD, a family physician in Arkansas, received a 30% Medicaid payment increase as a result of the parity provision. While he states that the provision provides a good first step towards improving Medicaid reimbursement rates, its short-term use does not address the larger issues of delivering quality care. Medicaid rates currently pay roughly 20% less than Medicare.

"The needs of my Medicaid patients are not going to go away (after 2014)," Dr Robinson said. "With Medicaid, we receive less money for taking care of a patient population that has the same or even greater healthcare needs as the general population."

Several states have had plans in place to enhance Medicare managed-care payment rates, but their implementation has been delayed. In fact, the AAFP reports that 33 states have The Centers for Medicare and Medicaid Services’ (CMS) approval, but they are still pending agreements from their managed-care companies on the negotiated prices.

For example, most Medicaid patients in Texas receive their care through managed-care plans. While The Texas Medical Association has received approval for its enhanced fee-for-service program, they still have yet to receive retroactive enhanced payments.

“What we're hearing is, 'We're working on it, we're working on it, we're working on it,'" Darren Whitehurst, vice president of advocacy for the Texas Medical Association, said in a recent article. “We've had Medicaid managed care since the '90s, so it seems like it would be a pretty simple thing to do. Somewhere there's been a snafu. It's not the doctors' fault. They've been doing everything they're supposed to be doing.”

Around the Web

State Medicaid Programs Slowly Coming Online With Parity Program [AAFP]

Docs Receiving Enhanced Medicaid Managed-care Pay in Just Six States, AAFP Says [Modern Healthcare]