By Sophia Duong

The Medicaid primary care bump now joins the likes of Emily Dickinson and Vincent Van Gogh – those that received credit only after their passing. After two years of raising Medicaid primary care rates up to Medicare levels, the rate bump expired on December 31, 2014. But weeks after its expiration, a new study from the University of Pennsylvania and the Urban Institute indicates the bump has succeeded in its goal of increasing access to care for Medicaid enrollees.

Secret shopper ‘patients’ called primary care doctors offices seeking new appointments in ten states: Arkansas, Georgia, Illinois, Iowa, Massachusetts, Montana, New Jersey, Oregon, Pennsylvania, and Texas. Researchers conducted these calls during two time periods, from November 2012 through March 2013, and then from May 2014 through July 2014. New appointment availability was measured for those in Medicaid and private insurance.

Let’s hit the highlights of the findings:

• For Medicaid patients, the average appointment availability increased from 58.7% before the payment increase to 66.4% after a mean increase of more than 50% in Medicaid reimbursement rates (a 7.7 percentage point increase in appointment availability! And this is statistically significant)
• New appointment availability remained about the same at 86% in both time periods for those with private insurance
• A 10% increase in Medicaid reimbursements was associated with an approximate 1.25 percentage point increase in appointment availability
• States with the largest Medicaid rate increases had the largest jump in appointment availability (New Jersey, Pennsylvania, Illinois, and Texas)
• Increases in appointment availability were similar in states that expanded Medicaid and states that did not expand

In summary, the study finds the rate bump increased access to care. These results also contribute to the broader conversation of low Medicaid reimbursement rates as a barrier for patients seeking care and for providers accepting Medicaid patients. Not only do we see this from the rate bump in Medicaid, but also in comparing appointment availability among Medicaid patients (66.4% with the bump) with those that have private insurance (86%).

The critical dialogue surrounding Medicaid’s low reimbursement rates isn’t new, but is currently being brought to the fore. Just last month, a federal court judge ruled that the low Medicaid reimbursement rates in Florida deprived children of necessary care. Earlier this week, the Supreme Court heard a case originally filed by providers in Idaho who were frustrated with their state’s Medicaid reimbursement rates (there are other nuances to this case, described here). Going forward, Medicaid reimbursement rates will continue to be a hot topic, and this analysis of the rate bump’s effectiveness will likely be a prominent piece of the conversation.

So what happens to provider rates now that the bump has expired? The Urban Institute estimated that provider rates are set to fall an average of 42.8 percent. Fee reductions vary by state, as depicted in the report. Despite little effort in Congress to continue the rate increase, a Kaiser survey finds 15 states will continue some sort of rate increase with state funds. Twenty-four states will return to payment levels before 2013, and 12 are left pondering to bump, or not to bump.