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ACA’s Medicaid Pay Bump Helped But Benefits Now Lost, Study Says

Health status and access to care improved for Medicaid patients when the Affordable Care Act mandated a temporary rate increase for physicians serving newly insured patients covered through that law’s Medicaid expansion.

But when the mandate for increased physician payments ended and state Medicaid programs reverted to their previous, lower payments, many of those benefits were lost.

Or so reports a new study from the National Bureau of Economic Research.

According to the study, even a $10 rate increase improved access to care enough to reduce by 13 percent Medicaid recipients’ complaints about not being about to find a doctor.  Utilization also increased.  The temporary Medicaid pay increase has even been credited with improving school attendance and reducing chronic absenteeism.

Despite the benefits of the temporary increase in Medicaid payments to physicians, most states returned to lower payments when the mandated ended, most of the gains resulting from the better pay for treating Medicaid patients disappeared, and the disparities between privately insured individuals and Medicaid patients returned to their pre-Affordable Care Act levels.

Researchers estimate that increasing Medicaid payments to physicians by an average of $26 a visit would eliminate disparities in access to care.

These findings are especially relevant to private safety-net hospitals because the communities they serve have so many more Medicaid patients than the typical American community.

Learn more from the National Bureau of Economic Resarch study “The Impacts of Physician Payments on Patient Access, Use, and Health” and from the Healthcare Dive report “Even $10 increase in Medicaid payments helps erase disparities in care access, study says.”

Despite Uncertainty, States Plan to Raise Medicaid Rates

Even though events in Washington leave the future of Medicaid unclear, 44 states still intend to raise at least some of their Medicaid rates in 2018.

Inpatient payments to hospitals are not among the major targets of the planned rate increases:  only 17 states plan to increase Medicaid inpatients payments while the others plan to keep those rates as they are or even reduce them.

Learn more about trends in Medicaid enrollment, spending, and rates in the Kaiser Family Foundation’s annual survey of state Medicaid programs, the results of which can be found here.

Are States Gaming New Medicaid Requirement?

Some doctors think so.

In a letter to the Centers for Medicare & Medicaid Services, the American Academy of Pediatrics, American College of Physicians, American Medical Association, and American Osteopathic Association suggest that two states have drastically cut their Medicaid rates, and others are contemplating doing so as well, in anticipation of implementation of a new Medicaid policy that requires states to track the impact of future rate reductions on access to care.

That requirement is part of a new rule addressing access to care that CMS issued last year.

By lowering rates now, the groups charge, states will establish a low baseline for future comparisons when analyzing the impact of rate reductions.

iStock_000008064653XSmallOne of the states that lowered payments is North Carolina. When it cut physician payments 23 percent last year, a survey of pediatricians found that 25 percent of them began limiting the number of new Medicaid patients they serve.

To learn more about why the groups are so alarmed, go here to read their letter to CMS.

CMS to Examine How States Set Medicaid Managed Care Rates

The Centers for Medicare & Medicaid Services (CMS) is launching an initiative to explore how states set the rates they pay managed care organizations to serve Medicaid patients.

cmsThe initiative consists of two parts:  first, CMS is examining the adequacy of the process states employ to set their rates – a process that affects the adequacy of the rates themselves; and second, it is drafting updated Medicaid managed care regulations.

Because private safety-net hospitals serve so many Medicaid patients, this effort could have a future impact on the payments they receive for serving these patients.

Learn more about this new undertaking in this Kaiser Health News report.