A two-year project is under way to encourage primary care doctors to accept Medicaid-eligible patients by paying for many services at the same level as Medicare.
Many poor or disabled patients have limited access to healthcare because so few doctors have been willing to accept the low Medicaid reimbursement rates.
The federal government will cover the difference between Medicare and Medicaid reimbursements for 146 primary-care services from Jan. 1 through the end of 2014. The increased payments will be made to family physicians, pediatricians and internal medicine doctors who specialize in primary care.
The program is winning praise from New Jersey doctors and primary-care advocates, who said it is an important step in increasing access to healthcare for low-income residents.
The two-year program was included in the 2010 Affordable Care Act. The state hasn’t announced when doctors will begin receiving the higher Medicaid rate, which will be paid retroactively for services provided beginning on Jan. 1.
“It will absolutely enhance the access of kids, particularly those who are poorer – to pediatric care,” said Dr. Alan Weller, associate director of general pediatrics at the University of Medicine and Dentistry of New Jersey’s Robert Wood Johnson Medical School.
New Jersey’s 109-percent increase in Medicaid primary care reimbursements will be the fifth-highest in the country under the program, according to a report by the Kaiser Family Foundation.
This is primarily the result of New Jersey having one of the nation’s lowest Medicaid reimbursement rates. The average increase nationwide will be 73 percent.
“We have given all of these kids cards for insurance but there was nothing really behind that,” said Weller, referring to the relatively low number of doctors who accepted Medicaid payments, which can be lower than the cost to doctors of providing the care.
While the two-year funding is focused on primary care, it also provides enhanced payments to pediatric subspecialists who provide the covered services.
“This is really tremendous and we’re really excited about the benefit this will provide to the kids,” Weller said.
U.S. Secretary of Health and Human Services Kathleen Sebelius said in November that strengthening Medicaid would help improve Americans’ health.
“By improving payments for primary care services, we are helping Medicaid patients get the care they need to stay healthy and treat small health problems before they become big ones,” Sebelius said in a statement announcing the rules implementing the program.
These rules give New Jersey a range of options in how it can apply the increased Medicaid funding. They do require the state to translate the increased funding to compensate doctors providing services through managed care organization Medicaid contracts so that they are equivalent to the fee-for-service payment model of Medicare.
The increased funding comes at a time when many states are expanding eligibility for Medicaid.
[link:https://www.njspotlight.com/stories/12/11/16/decision-to-expand-medicaid-coverage-in-new-jersey-is-christie-s-call/Gov. Chris Christie hasn’t announced whether New Jersey will join this expansion], which could affect 291,000 low-income adults, according to Urban Institute estimates. Christie has said that the state has little room to expand Medicaid after previous governors expanded the program. He’s also joined other Republican governors in asking federal officials for more details about the expansion.
Neither the New Jersey chapter of the American Academy of Pediatrics nor the new Jersey Academy of Family Physicians have surveyed their members on how many plan to add services to Medicaid-eligible patients.
While primary care doctors’ groups are welcoming the increased funding, their enthusiasm comes with a caveat – that the funding needs to be continued beyond 2014.
Weller said the state pediatricians group is concerned that some doctors will be wary of adding Medicaid-eligible children due to the expiration date.
“We need these kids to grow up healthy and, in order to do this, they have to have access to care,” Weller said.
Raymond Saputelli, executive vice president and CEO of the New Jersey Academy of Family Physicians, also said that the increased funding will increase access to primary care, but he fears what will happen in two years.
“Family physicians in primary care in New Jersey are already so challenged to maintain their sustainability that any uncertainty in payment rates makes it difficult for physicians to make any sort of long-term plans, investment in their practice,” or to consider new models for delivering healthcare, Saputelli said.
New Jersey Citizen Action, a nonprofit that advocates for low-income residents, has supported strengthening Medicaid funding.
“We know that finding doctors is a problem,” said Dena Mottola Jaborska, organizing director for Citizen Action. “They are just overwhelmed.”
Mottola said she experienced this firsthand when she sought a primary care doctor in Trenton and found that all of the doctors who accept Medicaid patients required long waiting periods to schedule appointments.
“There’s not enough of them, so the ones that take it are overwhelmed,” Mottola Jaborska said, adding that additional funding “would make it easier for Medicaid patients to have access to doctors.”
She added that the funding would become more important if the state expands Medicaid eligibility. Her organization has been a vocal advocate for the expansion.
“If we’re looking now at adding more Medicaid-covered patients to the patient load, we would want to see more doctors coming in and serving Medicaid patients,” she said.