Primary care to get $11 billion boost under Medicaid proposal


A two-year, $11 billion program announced May 9 by the Department of Health & Human Services will align Medicaid payments for primary care with payments made through Medicare.

Under the proposed rule, the federal government will pick up 100 percent of the difference between Medicaid payments and the corresponding rate paid under Medicare for a number of primary care and preventive services for two years beginning Jan. 1, 2013.

“One of the key goals of the Affordable Care Act is to promote primary care. We want to move to a system where care is improved for everybody,” said Cindy Mann, deputy administrator for the Centers for Medicare & Medicaid Services in a conference call announcing the proposed rule. “The regulations that we are proposing today implement a provision of the Affordable Care Act that is very explicitly designed to promote primary care and in the Medicaid program in particular.”

While states have different reimbursement structures under their Medicaid plans, Medicaid reimbursements on average are only about two-thirds of the reimbursements for the same services as paid by Medicare. Medicaid directors and the physicians who provide care to Medicaid patients see the increased payments as the first step in correcting this long-running discrepancy.

According to Roland Goertz, MD, board chair of the American Academy of Family Physicians (AAFP), nearly two-thirds of AAFP’s practicing members provide free and reduced-fee care to an average of eight patients a week.

Too often, Goertz noted, he and his colleagues see patients who have waited too long to get care and finally visit a doctor with an advanced disease state that could have been effectively treated if the patients had sought care earlier.

“We are the first contact patients have with the healthcare system,” Goertz said. “We don’t want that contact to be too late for preventive care or straightforward, cost-effective treatment.”

The increases in primary care payments should resonate with state Medicaid directors who have been forced by budget constraints to keep Medicaid reimbursement low -- budgets that have been additionally stretched by the increases in Medicaid recipients as a result of the economic recession.

Andy Allison, director of the Arkansas Medicaid program, said he is encouraged by the rule since it will get more children to see a primary care doctor when they need care, but also because it will help to both retain existing physicians and attract new ones to family practice.

“The additional funding for primary care will provide resources so physicians and their care teams can invest the time to be more familiar with each person’s need and history and address the patient’s full range of needs effectively (and) efficiently,” Allison said during the conference call. “It all takes time and is an investment that heretofore we haven’t paid enough for.

“I know it is true in Arkansas and I’m sure it is true in other states. This boost in reimbursement to primary care we see as an investment in Medicaid’s relationship with providers at a time when that relationship is more important than ever.”

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