NYT: As Medicaid Rolls Swell, Cuts in Payments to Doctors Threaten Access to Care (Dec 28, 2014)

Just as millions of people are gaining insurance through Medicaid, the program is poised to make deep cuts in payments to many doctors, prompting some physicians and consumer advocates to warn that the reductions could make it more difficult for Medicaid patients to obtain care.

The Affordable Care Act provided a big increase in Medicaid payments for primary care in 2013 and 2014. But the increase expires on Thursday — just weeks after the Obama administration told the Supreme Court that doctors and other providers had no legal right to challenge the adequacy of payments they received from Medicaid.

The impact will vary by state, but a study by the Urban Institute, a nonpartisan research organization, estimates that doctors who have been receiving the enhanced payments will see their fees for primary care cut by 43 percent, on average.

Stephen Zuckerman, a health economist at the Urban Institute and co-author of the report, said Medicaid payments for primary care services could drop by 50 percent or more in California, Florida, New York and Pennsylvania, among other states....

Dr. George J. Petruncio, a family physician in Turnersville, N.J., described the cuts as a “bait and switch” move. “The government attempted to entice physicians into Medicaid with higher rates, then lowers reimbursement once the doctors are involved,” he said....

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Urban Institute: Reversing the Medicaid Fee Bump: How Much Could Medicaid Physician Fees for Primary Care Fall in 2015? (December, 2014)

To date, 27 states and the District of Columbia have expanded eligibility for their Medicaid programs, and those states have reportedly added more than 7.5 million Medicaid enrollees since the third quarter of 2013 (Centers for Medicare and Medicaid Services 2014). Because of long-standing concerns about the level of physician reimbursement in the Medicaid program and its effect on physicians’ willingness to accept Medicaid patients, the ACA also includes a mandatory two-year increase in Medicaid fees for primary care services to Medicare levels. This increase is fully funded by the federal government and raises fee-for-service and managed-care Medicaid fees for certain primary care services provided by family physicians, internists, and pediatricians from January 1, 2013, through December 31, 2014. Using fee-for-service data from 2012, the Urban Institute estimates that this primary care “fee bump” would increase fees by approximately 73 percent on average (Zuckerman and Goin 2012). As of June 2014, the federal government had spent an estimated $5.6 billion on the fee bump (Medicaid and CHIP Payment Access Commission 2014)....

...To date, it is unclear whether the increase in Medicaid primary care payment has had an effect on the number of physicians accepting Medicaid or the number of Medicaid patients that physicians are willing to see, and anecdotal evidence is mixed (Crawford and McGinnis 2014). For example, although Connecticut has reported a significant increase in the number of participating physicians after the fee bump, other states expect little or no effect (Snyder, Paradise, and Rudowitz 2014).

Without an act of Congress, the federally funded payment increase will expire on December 31, 2014.  As of October 28, 2014, 15 states had indicated their intent to continue the fee increase in 2015 using state funds, 24 states had said that they did not intend to continue the fee increase, and 12 states were undecided (Snyder, Paradise, and Rudowitz 2014). This paper uses data from the Urban Institute’s 2014 survey of Medicaid physician fees to estimate how large a reduction in Medicaid primary care fees will occur on January 1, 2015, if the ACA’s Medicaid primary care fee bump expires....

Hawaii

−46.1% -- Expected fee decrease for ACA primary care services for eligible physicians in 2015 (%)

0.54 -- Medicaid-to-Medicare fee index for ACA primary care services for noneligible physicians

Yes -- State plans to extend fee increase through 2015

Average -- Primary care physician acceptance rate for new Medicaid patients, 2011–12

Yes -- State expanded Medicaid as of 11/2014

Hawaii 2014 Medicaid fee indexes

0.96 -- All Services

0.98 -- Primary Care

0.83 -- Obstetric Care

1.08 -- Other Services

Hawaii 2014 Medicaid-to-Medicare fee indexes

0.62 -- All Services

0.56 -- Primary Care

0.64 -- Obstetric Care

0.76 -- Other Services

Hawaii -- Cumulative Percentage Change in Medicaid Fees, by Type of Service, 2012–14

0.00 -- All services (%)

0.00 -- Primary care (%)

0.00 -- Obstetric care (%)

0.00 -- Other services (%)

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Dec 29, 2014: Briefing: Doctors Discuss Challenge of Working With Medicaid