NEJM Study Shows Increase in Medicaid Reimbursement Improved Access to Care February 4, 2015 Advocacy, Medi Cal, Medicaid, Primary Care We Care for California, Medi-Cal 0 A study published in the New England Journal of Medicine shows that the increase in Medicaid reimbursement for primary care providers, a key provision of the Affordable Care Act (ACA), resulted in an increase in new patient appointment availability without longer wait times. The study, conducted by the University of Pennsylvania and the Urban Institute, used “secret shoppers” to call primary care doctors offices seeking new appointments in 10 states: Arkansas, Georgia, Illinois, Iowa, Massachusetts, Montana, New Jersey, Oregon, Pennsylvania and Texas. Calls were made in two time periods, from November 2012 through March 2013 and May 2014 through July 2014. While the study did not examine California specifically, it did find that “states with the largest increases in availability tended to be those with the largest increases in reimbursements.” In California, the primary care rate increase more than doubled the rate these providers would have gotten without this key provision in the ACA. The study provides the first research-based evaluation of the association between the ACA’s two-year Medicaid fee increase—for which federal funding expired on December 31, 2014—and access to care for Medicaid patients seeking new patient primary care appointments at physician offices. For Medicaid patients, the average appointment availability increased 7.7%, from 58.7% to 66.4%, between the two time periods. There was no change in wait times for appointments. In California, physicians are faced not only with the expiring ACA pay bump, but also a 10% provider reimbursement cut authorized by AB 97 in 2011. California’s abysmally low provider reimbursement rates, which have not been adjusted for increasing costs in two decades make it very difficult for physicians to accept new Medi-Cal patients—placing roadblocks for patient access to care. As a result, 56% of Medi-Cal patients report difficulty finding a doctor. California’s Medi-Cal provider payment rates were some of the lowest in the nation. Medi-Cal physicians are currently paid roughly $16 for a regular, primary care visit. For many practices, this is simply unsustainable. SFMS is part of the CMA-led “We Care for California” coalition for increased Medi-Cal reimbursements. In order to ensure Californians have real access to care, the coalition is advocating for permanent increase of Medi-Cal rates to Medicare levels. SFMS will be meeting with Assemblymembers David Chiu and Phil Ting this week to discuss accessible health care for all Medi-Cal patients. Comments are closed.
