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Unsurprisingly, the best-paying states, like Wyoming and Alaska, also enjoyed broad physician acceptance of Medicaid, whereas poorly paying states, like New York, New Jersey, and California, had the opposite effect. Mostly, the blue states that have been most aggressive in expanding their Medicaid programs are the ones that have had to rein in costs by paying doctors less, leading to poorer Medicaid access.
Decker ends her piece on an optimistic note, pointing out that Obamacare temporary increases Medicaid’s fees for primary care physicians in 2013 and 2014. As Sarah Kliff
observes, “some interest groups already
have their eyes on an extension” of the fee bump. In the current fiscal environment, however, it’s hard to see how that fee bump would continue.
Indeed, in the absence of permanent reform, states are continuing to reduce, not increase, their Medicaid fees. States can’t borrow money from China, the way the federal government does. States are already cutting back on education and infrastructure spending in order to feed the Medicaid beast. As Obamacare strives to add 17 million more people to the Medicaid rolls, this problem is going to get worse, not better.
UPDATE: Phil Galewitz of Kaiser Health News
talks to a doctor in New Jersey, who says that the Medicaid fee bump won’t make a difference to him, because of its temporary nature:
Robert Maro Jr., a Cherry Hill, N.J. internist, said he has not accepted new Medicaid patients for 15 years because of low pay. He notes the state reimburses him only about $23.50 for a basic office visit, less than half of what he gets from
Medicare or private insurers.
Maro said he treats Medicaid patients in the hospital and in nursing homes, but he would lose money treating them in the office where his administrative costs are higher.
He said he would start seeing new Medicaid patients only if knew the pay hike under the health law would continue beyond 2014. Otherwise, he worries he would take on new patients only to see rates fall back to the old levels in 2015, and then he would be required legally and ethically to keep treating them.
“That would be a nightmare,” he said…
New Jersey Medicaid officials acknowledge the lack of physician participation is a problem, but said the recent move to enroll nearly all Medicaid recipients into private managed care plans “should reverse the trend,” said Nicole Brossoie, spokeswoman for the New Jersey Department of Human Services which oversees Medicaid.
Many states have contracted with private managed care companies for the care of Medicaid patients to cut costs and improve care. Brossoie said those companies can pay higher rates to doctors to get them to join their networks, and the state holds the firms accountable for making sure members have access to providers.
New Jersey has not completed any studies measuring patients’ access to care in Medicaid managed care plans, Brossoie said.
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