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June 20, 2016

Low reimbursement rates are limiting Medicaid expansion's potential, report finds

Daily Briefing

    Low provider reimbursement rates under Medicaid have limited the effect of the Affordable Care Act's Medicaid expansion on access to care, according to a report presented to an American Medical Association (AMA) panel.

    Limited provider participation, long wait times

    The report noted that while Medicaid expansion has increased access to health insurance, those coverage gains have not necessarily increased U.S. residents' access to health care. The report listed low Medicaid reimbursements for providers as a key obstacle.


    The report noted that among state Medicaid plans, half of health care providers listed in the plans' networks either were not participating in the plan at the location provided or were not accepting new patients who were Medicaid beneficiaries. In addition, the report found that patients faced wait times of at least four weeks at more than 25 percent of participating providers.

    Report recommends advocacy, oversight

    The report recommended that AMA should "continue to advocate that CMS develop a mechanism for physicians to challenge payment rates directly to CMS."

    The report also called on AMA to urge CMS to "provide strict oversight" to make sure states set Medicaid provider payment rates "at levels to ensure there is sufficient participation."

    In addition, the report recommended that state medical societies proactively develop strategies to measure Medicaid beneficiaries' access to care.


    "I think most of us in most states don't see Medicaid as one of our better payers," says Robert Hertzka, who chairs AMA's Council on Medical Service.

    However, Jay Gregory, an Oklahoma-based physician, says the report was unclear and that it seems contradictory for AMA to ask CMS to monitor physician payment rates when the rates already are low. He also questions whether AMA could enable physicians to effectively challenge Medicaid rates at the federal level. "How many times have we ever challenged payment rates at CMS and walked away as winners?" he asks (Clark, MedPage Today, 6/13; Kuhrt, FierceHealthcare, 6/14).

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