A new policy brief from Health Affairs and the Robert Wood Johnson Foundation (RWJF) examines how states have dealt with the expiration of the Affordable Care Act’s (ACA) Medicaid primary care fee bump.
This provision required states to raise Medicaid primary care payments to make them comparable with those of Medicare; the federal government, not the states, subsidized the increase for 2013 and 2014. Federal lawmakers failed to renew the program at the end of last Congress. So in 2015 only sixteen states and the District of Columbia took on the additional costs of continuing to pay Medicaid providers at the enhanced rate. This policy brief describes the program and its impact.
What’s the Background?
As the brief explains, the provision was implemented so more primary care providers would accept Medicaid beneficiaries. The research linking Medicaid payments and Medicaid patients’ access to care has not been consistent. Still, many policy makers believe that the provider payment is an important component to ensure that Medicaid beneficiaries will be accepted by providers. The brief reviews the range of Medicaid/Medicare primary care fee ratios by state, outlines how Section I202 was enacted and rolled out, and details the different states’ response to the Medicaid fee bump’s discontinuation after 2014.
What’s the Debate?
According to the brief, in the absence of conclusive research about the impact of the Medicaid bump, there is disagreement about the aftermath of its expiration. Some stakeholders speculate that these providers will again refuse to care for these patients, leading to worse health outcomes. Others argue that the program merely rewarded those who were already participating in Medicaid.
What’s Next?
The brief notes that Congress is unlikely to revisit the Medicaid fee bump’s resumption anytime soon. With a third of the states continuing to pay the enhanced fees, future research will help determine the most effective use of payment as a lever to improve access. Meanwhile, as the brief suggests, more providers are adopting value-based payment models, potentially making the program’s fee-for-service paradigm obsolete.
About Health Policy Briefs
Health Policy Briefs are aimed at policy makers, congressional staffers, and others needing short, jargon-free explanations of health policy basics. The briefs, which are reviewed by experts in the field, include competing arguments on policy proposals and the relevant research supporting each perspective.
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Please feel free to forward the briefs to any of your colleagues who are tracking health issues. And after you’ve taken a look, we welcome your feedback at: hpbrief@healthaffairs.org.
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