Primary care providers in most states will see their reimbursement for evaluation and management (E/M) services increase thanks to a portion of the Affordable Care Act (ACA) calling for payment parity between the Medicare and Medicaid programs. 
The payment increases are designed to encourage physicians, nurse practitioners, and other primary care providers to accept Medicaid patients. Many providers have stopped accepting Medicaid patients due to the program’s low reimbursement rates. Each state program pays primary care providers at a different rate, but the national average for Medicaid payments for primary care services is 59% of the Medicare fee schedule. One of the ACA’s key provisions is expanding Medicaid coverage to more Americans; but that extension is moot if providers refuse to take patients with the plan. To make payments even with Medicare, the Kaiser Family Foundation estimates 2013 Medicaid fees will increase by an average of 73% nationally. However, not all state Medicaid programs will see an increase. Programs in North Dakota and Alaska currently pay primary care providers more than Medicare for primary care services. As a result, payments will remain the same in those states. On the other hand, six states (California, Florida, Michigan, New Jersey, New York, and Rhode Island) will see their Medicaid fee rates more than double. Medicaid programs in each of these six states paid less than half of what Medicare pays for E/M services and vaccine administration in 2012. As a result, Medicaid payment rates will increase 136%, 105%, 125%, 109%, 156%, and 198% respectively. Last month, physician groups feared that a fiscal cliff deal would eliminate Medicaid hikes, but the January 2 deal left them intact.
The payment increases are designed to encourage physicians, nurse practitioners, and other primary care providers to accept Medicaid patients. Many providers have stopped accepting Medicaid patients due to the program’s low reimbursement rates. Each state program pays primary care providers at a different rate, but the national average for Medicaid payments for primary care services is 59% of the Medicare fee schedule. One of the ACA’s key provisions is expanding Medicaid coverage to more Americans; but that extension is moot if providers refuse to take patients with the plan. To make payments even with Medicare, the Kaiser Family Foundation estimates 2013 Medicaid fees will increase by an average of 73% nationally. However, not all state Medicaid programs will see an increase. Programs in North Dakota and Alaska currently pay primary care providers more than Medicare for primary care services. As a result, payments will remain the same in those states. On the other hand, six states (California, Florida, Michigan, New Jersey, New York, and Rhode Island) will see their Medicaid fee rates more than double. Medicaid programs in each of these six states paid less than half of what Medicare pays for E/M services and vaccine administration in 2012. As a result, Medicaid payment rates will increase 136%, 105%, 125%, 109%, 156%, and 198% respectively. Last month, physician groups feared that a fiscal cliff deal would eliminate Medicaid hikes, but the January 2 deal left them intact.
