Through the Affordable Care Act, the federal health-care reform law, Medicaid payments will increase for many primary care physicians for two years starting in January. Some physicians and experts say the payment bump will mean more low-income patients will receive care. However, they add that more reform is needed to keep those extra patients covered for the long-term.
According to the Centers for Medicare and Medicaid Services, the provision in the law taking effect Jan. 1 will be totally funded by the federal government and will increase Medicaid reimbursement payments to primary care physicians in the fields of family medicine, pediatrics and internal medicine. The goal of the increase is to entice more physicians to accept Medicaid payments along with helping those who already take money from the program. The increase will be particularly helpful for Alabama, which currently has a struggling Medicaid program because of decreasing state revenue.
Medicaid is funded by state and federal money and mainly pays for medical and long-term care for low-income children, pregnant women, individuals with disabilities and nursing home residents.
Dr. Angela Martin of Anniston’s Pediatric Care Center of Northeast Alabama said the increase will be particularly helpful for her practice and patients, 70 percent of who use Medicaid.
“We’re excited about getting an increase in pay,” Martin said. “It will position us to help more patients … it may only be two years of an increase, but that is certainly better than none.”
The increase, which will cost $11 billion and be 100 percent federally funded, will mean an approximately 30 percent increase in Medicaid reimbursement payments to physicians. According to the Alabama Medicaid Agency, which administers Medicaid for the state, the boost will pump an extra $40 million into Alabama’s program next year and have an impact on about 8,000 primary care physicians.
State funding for Medicaid has been shrinking the last few years due to decreasing revenue. Earlier this year, voters approved a state constitutional amendment to transfer $140 million from the Alabama Trust Fund to the state General Fund to shore up the Medicaid program and close a $100 million deficit. Still, Alabama has one of the lowest Medicaid reimbursement rates in the country, meaning many physicians are unwilling to accept patients in the program.
More than 1 million patients receive health care through Medicaid in Alabama every year.
Dr. Carla Thomas, who practices family medicine in Anniston, said she also believes the increase will help many physicians and patients. About 20 percent of Thomas’ patients use Medicaid, she said.
“It will be a nice increase,” Thomas said. “It will help more clinicians become willing to take Medicaid.”
Julia Paradise, analyst with the Kaiser Family Foundation’s commission on Medicaid and the uninsured, said there is some research to suggest the payment bump will bring more physicians to Medicaid. Kaiser is a nonprofit, nonpartisan group focusing on health care issues facing the country.
“It’s reasonable to hope more physicians will take it,” Paradise said. “These are large increases.”
Paradise added that if the increase works as planned, more states might be willing to extend the program on their own after the federal funds dry up.
“I think states … if the impact is to improve physician participation, there’s going to be wide interest in sustaining the increase,” Paradise said. “But financing it is going to be the challenge.”
Don Williamson, state health officer for the Alabama Department of Public Health and the chairman of the Alabama Medicaid Advisory Commission, said extending the increase will be one of many topics under discussion regarding the state Medicaid program in the next few years. Gov. Robert Bentley established the Medicaid Advisory Commission last week to find ways for the state’s Medicaid program to provide better care, cut costs and spend money more efficiently.
“We’ve got to come up with finding a better delivery system,” Williamson said of state Medicaid. “It’s impossible not to have a discussion around the expansion of patients and if that helps or hurts the long-term expandability of Medicaid.”
Williamson noted that he expects the increase will help the state in the short-term.
“It absolutely will help physicians to take Medicaid patients,” Williamson said. “But the state will have to either come up with funding to sustain that or roll it back.”
Jim Carnes, spokesman for Alabama Arise, a nonpartisan group that advocates for low-income residents, agreed that the increase will help underserved patients. However, he added that plans should be made now to sustain the increase.
“We’re hopeful it will strengthen the network and secure access,” Carnes said of the increase. “But it’s important we start looking at how the state is going to fill that gap after two years – access to health care providers in Alabama today is a critical challenge.”
Star Staff writer Patrick McCreless: 256-235-3561. On Twitter @PMcCreless_Star