Effect of Medicaid pay bump difficult to judge

The long-term effect of the so-called Medicaid pay bump mandated by the Affordable Care Act in 2013 and 2014 remains to be seen, according to a Health Affairs analysis.

The ACA required states to raise Medicaid primary care payment rates to Medicare levels in 2013 and 2014, with the federal government covering the difference, Health Affairs noted. In 2012, Medicaid fee-for-service payment rates averaged only 59 percent of Medicare payment rates.

Total spending for the Medicaid pay bump program in 2013 and 2014 will likely reach $12 billion. The program ended in December 2014 after Congress failed to reauthorize it; 16 states and the District of Columbia opted to keep the program in place without the federal match. Medicaid payments for primary care physicians dropped dramatically in the states that ended the fee bump program, FiercePracticeManagement previously reported.

New England Journal of Medicine study found that increasing Medicaid payments did seem to boost appointment availability, which is especially important in the era of Medicaid expansion, with as many as 1 in 5 Americans now covered by the program.

However, Health Affairs argued, two years of data isn't enough to determine whether the fee bump program increased provider participation or simply benefitted providers who already accept Medicaid patients. This may have stemmed, in part, from a requirement that providers self-attest to their eligibility for the program, as well as from limited outreach programs that targeted those already accepting Medicaid patients.

If nothing else, Health Affairs concluded, the fact that some states have continued to offer the Medicaid pay bump but others have not provides a "natural experiment" to see if the program represents an effective way to improve access to primary care.

For more:
read the Health Affairs post

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