Medicaid Rates Are Going Down & There Is Nothing Doctors Can Do About It


By Shirie Leng, M.D.

Medicaid is a federal program for the very poor implemented by grants to states, which do the administration.  Medicaid typically pays doctors about 60 percent of what Medicare pays.  In Florida, a typical primary care visit might pay the doctor $32.  In Alabama, doctors who agree to be the primary care physicians of record for Medicaid patients get a whopping $2.60 per beneficiary per month, a fee with which the doctor has to maintain 24 hour office availability and use EMR.

Under federal law, Medicaid rates must be “sufficient to enlist enough providers” so that beneficiaries have at least as much access to care as the general population in their geographic area (the equal access requirement). Whatever that means.  But the Obama administration told the Supreme Court that health care providers had no legal right to enforce the equal access requirement in court. This section of the Medicaid law provides guidance to federal and state officials in setting Medicaid rates, but does not allow health care providers to sue state officials to enforce it.  This was in response to the latest attempt to sue the government to enforce this law, Armstrong v. Exceptional Child Center, Inc.  (The Exceptional Child Center, in Idaho, provides residential rehab for children with disabilities.)

As most of you know, the ACA expanded Medicaid coverage, or at least offered expanded Medicaid coverage, to the states. 9.7 million people have been added to the Medicaid rolls since October 2013, bringing the total to 68.5 million. More than one-fifth of Americans are now covered by Medicaid. So, in order to entice physicians and nurse practitioners to accept all these new, often complicated patients, the government hiked up the reimbursement rates for Medicaid patients.

For the last two years, the federal government has required state Medicaid agencies to pay at least as much as Medicare pays for primary care services.  But only for two years.  In 2015, the reimbursement rates go back to 2012 levels.  $2.60 per patient per month, in the case of Alabama.  A rate that providers can’t challenge in federal court.

Where’s the clause that says doctors get to have equal access to enough money to feed their children?

Shirie Leng, a former nurse, is an anesthesiologist who blogs at medicine for real.