Medicaid rate rises for some doctors, but will it increase patient access?

Connecticut doctors who treat Medicaid patients haven’t exactly been richly rewarded, with payment rates far below what other insurers pay. Many practices don’t take Medicaid patients, or don’t take many.

But as of this month, primary care doctors are getting a big -- but temporary -boost in their payments for seeing Medicaid patients, funded by the federal government.

The two-year bump in payments, required as part of the federal health reform law, means that for some services, primary care doctors will see their Medicaid fees nearly double.

Until this month, primary care doctors were paid $66.40 to see a new Medicaid patient. Now the rate is $123.53. An urgent care visit for an established Medicaid patient used to earn a physician $42.93. Now it brings in $82.98.

The increase was intended to address concerns that low payment rates keep doctors from participating in Medicaid, and that as more people gain Medicaid coverage next year under the federal health reform law, existing patients could have a harder time getting a doctor to see them.

Will the temporary new rates make it easier for Medicaid patients to find a doctor to treat them?

“I think it’s going to be a real game changer for access,” said Douglas Arnold, CEO of MPS, a Middletown-based association of doctors in independent practice.

He said the new rates put Medicaid reimbursement above what some private insurance pays.

“When I show these new rates to my primary care doctors, their jaws drop,” Arnold said. Others are less confident. “I think the rates are an issue, but it’s not the only issue” keeping doctors from participating in Medicaid, said Ellen Andrews, executive director of the Connecticut Health Policy Project.

In particular, she said, other barriers to participating include administrative issues involved in becoming a participating doctor in the program and delays in getting paid.

It’s too soon to tell if the new rates will improve access, said Dr. Rob Nardino, who serves as governor of the Connecticut chapter of the American College of Physicians, which represents internists.

But he pointed to another potential barrier: Full practices.

“I think many physicians are feeling that it will be hard to increase access anyway, regardless of who’s paying, just because the practices are busy,” said Nardino, a New Haven internist who practices at Yale-New Haven Hospital’s St. Raphael campus.

In a report released last month, the Medicaid and CHIP Payment and Access Commission, which makes recommendations to Congress about the programs, said that Medicaid officials and provider organizations in several states expressed concern that the effect of the rate increase could be limited since it’s set to expire after next year.

“Several of the states included in our interviews indicated that they are unlikely to be able to maintain the rates in 2015 and beyond without the enhanced federal matching,” the report said.

Dr. Robert Zavoski, medical director for the state Department of Social Services, said one way to view the increase is as a two-year pilot program. But he said it will be challenging to evaluate the effect the rate increase has because the federal government took a long time to get states the information needed to implement the changes. As a result, Connecticut didn’t put the new rates in place until six months into the two-year window, and many other states haven’t done so yet.

“It’s regrettable that we may not be able to fully gauge what the impact of all this really is,” he said Friday during a meeting of the council that oversees Medicaid. “We’re going to do our very best.”

Technically, the rate increase will cover this and next calendar years, but the state only began paying the higher fees July 1. It’s expected to issue about $30 million in retroactive payments in September for services delivered from earlier this year.

This fiscal year, the rate increase is expected to cost $73 million, which will be fully reimbursed by the federal government.

State Medicaid programs vary widely in how they compensate doctors, and the rate hike is intended to make all of them pay primary care doctors at the same rate Medicare does. In Connecticut, Medicaid rates for primary care paid 71 percent of what Medicare did in 2012, according to the nonpartisan Kaiser Family Foundation.

Currently, 2,277 Connecticut doctors have completed the process necessary to be eligible for the higher payments.

The increase applies to internists, family doctors and pediatricians, as well as nurse practitioners who work under an eligible doctor. It doesn’t apply to obgyns, who often serve as women’s primary care physicians. Connecticut’s Medicaid rates for those providers are already nearly 25 percent higher than what Medicare pays.

Sharon Langer, interim executive director of Connecticut Voices for Children, noted that since the rate increase is limited to primary care, the change won’t affect one long-standing problem for Medicaid patients -- finding specialists to treat them.

Still, Langer said the hope is that raising the rates will help attract new primary care providers to the program, and ensure that those who already participate continue to do so.

A report released earlier this week by Connecticut Voices for Children found that access to dental care in the state’s HUSKY program has consistently improved since a series of reforms were implemented in 2008, including increased rates paid to dentists. HUSKY includes both Medicaid and the Children’s Health Insurance Program, which covers children whose parents earn too much to qualify for Medicaid.

The percentage of children and adolescents in the HUSKY program who received any dental care rose from 51.9 percent in 2006 to 73.8 percent in 2011. Among children under 3, the rate rose from 21.1 percent in 2008 to 41.6 percent in 2011. The report noted there were persistent racial and ethnic disparities in the rates of use of dental care, with the highest rates among Hispanic children and lowest among black and African American children.

The changes, precipitated by the settlement of a class action lawsuit, included spending $80 million over four years to increase the reimbursement rates paid to dental providers for seeing children, as well as increased fees for those seeing adults. But there were also changes beyond the increased payment rates, including money awarded to dental clinics in schools and community-based settings, changes in the administrative handling of the HUSKY dental program and a major outreach and recruitment effort to get more dental providers to participate in Medicaid.