By Marissa Evans, CQ Roll Call
April 2, 2015 -- California, Florida, Louisiana, New Jersey, and New York–area physicians were the least likely to accept new Medicaid patients in 2013, just as states were increasing reimbursement rates for the low-income health insurance program under the Affordable Care Act, according to a new federal report.
The Centers for Disease Control and Prevention 2013 National Electronic Health Records Survey report found that just 38.7 percent of New Jersey physicians said they accepted new Medicaid patients that year—below the national average of nearly 69 percent. Meanwhile, among California physicians 54.2 percent accepted Medicaid patients. Florida, Louisiana, and New York doctors rounded out the top five states.
Under the health care law, the federal government gave states money for Medicaid payment rates for primary care physicians to equal Medicare rates for 2013 and 2014. However, many states experienced delays in implementing payment increases and didn't do so until later on in 2013. The reimbursements aren't reflected in the new report.
Elisabeth Burak, senior program director for Georgetown University's Center for Children and Families, said the temporary reimbursement increase enticed more doctors to join Medicaid. She said it will be important to see next year's report and if there was an increase in the number of participating physicians.
"The really interesting news is going to be in 2014 to see what the trend looks like then since that [reimbursement] bump had an impact," Burak said. "What we're seeing is a lot of states are choosing to continue those rate bumps themselves at their own cost."
Federal funding for the rate increase expired at the end of 2014, but Alaska, Alabama, Colorado, Connecticut, Delaware, Hawaii, Iowa, Maryland, Maine, Michigan, Mississippi, Nebraska, Nevada, New Mexico, and South Carolina have chosen to pay out of pocket to keep the rate increases, according to a Kaiser Family Foundation survey. Twenty-four states will return to payment levels before 2013 while a dozen states haven't decided whether they'll maintain the rate increase.
Lawrence Downs, CEO for the New Jersey Medical Society, said that it's not surprising physicians aren't taking on as many Medicaid patients since the state's Medicaid reimbursement rate is one of the lowest in the country compared to Medicare reimbursement. Republican New Jersey Gov. Chris Christie is proposing an additional $45 million go toward physician reimbursements under the state's Medicaid program in his 2016 budget.
"I don't know if it's enough to bring the payments up to parity with Medicare but it's certainly an important investment for the state to make," Downs said.
Matt Salo, executive director for the National Association of Medicaid Directors said "100 percent physician participation is not high on that list of things" state Medicaid programs are trying to accomplish. He said beyond reimbursement rates, how health plans establish provider networks, ease of Medicaid administrative issues and overall commitment to treat low income patients are what drives doctor participation in the program.
"Some providers would rather see uninsured patients because with the uninsured they can write it off but with Medicaid there are rules," Salo said. "They'd rather do their own thing and provide care and know they're not going to get paid than deal with bureaucratic hassles."
