By Dr. Marsha Raulerson, Fellow of the American Academy of Pediatrics
Across the country, Medicaid and the Children’s Health Insurance Program (CHIP) provide health coverage to more than 43 million children, including half of all low-income children in the United States. This summer, I cared for one of those children. In August, a 17 year old rising high school senior came to see me because he discovered a mass on his neck. Medicaid immediately approved a CT scan, which revealed a tumor. The very next day, he was at Alabama’s children’s hospital 200 miles away starting care for what has been diagnosed as Hodgkin’s Lymphoma. While this disease is a scary diagnosis for any young person, Medicaid’s quick and comprehensive coverage of services allowed him to access the care he needed to begin treatment right away.
I am proud to report that Alabama state legislators understand the value of Medicaid for children in our state. Earlier this year, they made a landmark investment in children’s health by using our own state funding to extend the Affordable Care Act’s Medicaid payment increase for primary care services. Pediatricians often provide care for a large portion of Medicaid patients in a community, but unfortunately, Medicaid has historically paid well below Medicare rates for the same services. For example, as a national average, a pediatrician treating a child on Medicaid is paid about two-thirds of what is paid by Medicare for the same service or treatment. Recognizing the payment disparity and its effects on access to care, Congress increased Medicaid payment rates to at least Medicare rates for primary care services in 2013 and 2014 as part of the Affordable Care Act. This federal funding runs out on January 1, 2015, if Congress does not act.
Thankfully, our state leaders in Alabama understand how vital Medicaid is to children in our community and how important payment is to making health insurance work. Dr. Donald Williamson, Alabama’s State Health Officer, emphasized to our legislators that the Medicaid payment increase is essential to stabilize the physician workforce in the face of major Medicaid reforms in our state. Physician participation in the Medicaid program is a concern in Alabama, because 22% of enrolled primary care physicians now receive 90% of all Medicaid claims payments. My patients come from a large rural area in lower Alabama and 70% of these children are enrolled in Medicaid. Nationally, 47% of children in rural communities depend on Medicaid or CHIP.
I have talked to several pediatricians about the impact on their practices of the increased Medicaid payment. One office will recruit two more pediatricians to better serve their community, another talked about finally having the funds needed to upgrade computers and other office equipment, and another pediatric group was able to increase their support staff. These improvements allow pediatricians to have the resources and support they need to give the best possible care to their patients.
Unfortunately, this is not the case in many states across our country, where children and families are facing insurmountable barriers when trying to access the medical care they need when they need it. A child in Alabama should have the same opportunity to receive good care as a child in Texas or Rhode Island. If our national leaders follow Alabama’s example, children will be better off for it.
Marsha Raulerson, MD, a Fellow of the American Academy of Pediatrics, has practiced community pediatrics in Brewton, AL for 33 years. She chairs the Academy’s Committee on Federal Government Affairs.