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January 4, 2015

This post falls squarely in the category of WTF?

Medicaid is a Federal program for the very poor implemented by grants to States, which do the administration.  Medicaid typically pays doctors about 60% of what Medicare pays.  In Florida, a typical primary care visit might pay the doctor $32 dollars.  In Alabama doctors who agree to be the primary care physicians of record for medicaid patients get a whopping $2.60 per beneficiary per month, a fee with which the doctor has to maintain 24 hour office availability and use EMR. (Medpac: Report to the Congress: Medicare and the Health Care Delivery System, 2014).

Under Federal law, Medicaid rates must be “sufficient to enlist enough providers” so that beneficiaries have at least as much access to care as the general population in their geographic area (the “equal access” requirement)  Whatever that means.  But the Obama administration told the Supreme Court last month that health care providers had no legal right to enforce the “equal access” requirement in court. This section of the Medicaid law provides guidance to federal and state officials in setting Medicaid rates, but does not allow health care providers to sue state officials to enforce it, said Donald B. Verrilli Jr., the solicitor general of the United States (Robert Pear, NYT, Dec 27th).  This was in response to the latest attempt to sue the government to enforce this law, Armstrong v. Exceptional Child Center, Inc.  The Exceptional Child Center, in Idaho, provides residential rehab for children with disabilities.

As most of you know, the ACA expanded Medicaid coverage, or at least offered expanded Medicaid coverage, to the states.  9.7 million people have been added to the Medicaid rolls since October 2013, bringing the total to 68.5 million. More than one fifth of Americans are now covered by Medicaid. So, in order to entice physicians and NPs to accept all these new, often complicated patients, the government hiked up the reimbursement rates for medicaid patients.  For the last two years, the federal government has required state Medicaid agencies to pay at least as much as Medicare pays for primary care services.  But only for two years.  This week the reimbursement rates go back to 2012 levels.  $2.60 per patient per month, in the case of Alabama.  A rate which providers can’t challenge in Federal court.  Where’s the clause that says doctors get to have “equal access” to enough money to feed their own children?



From → Health Insurance

One Comment
  1. I think what the expectation is, is that a mix of some of these patients will be paid for by the other groups that you look after. I also think it is very unhelpful to the cause of saying docs don’t have enough money to feed their kids. Lets face it, I see more and more doctor/doctor couples and no one in the family is hurting. For example, an obgyn alone I know takes down $100K a year *after* taxes.

    It would probably be more helpful if you indicated less about doc pay than the multiple layers of admin and buildings with waterfalls that do nothing for patient care, rather than doc pay. Suggestion only.

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