By Anne Edwards, M.D., FAAP, Chair of the American Academy of Pediatrics Committee on State Government Affairs
Pediatricians and other child advocates continue to work with their state Medicaid programs to implement a significant provision in the Patient Protection and Affordable Care Act (ACA) to increase access to care in the program. Long sought by the American Academy of Pediatrics, the Medicaid payment provision sends states federal funds to increase Medicaid rates to at least Medicare levels for primary care and immunization services in 2013 and 2014.
In the ACA, the federal government recognized that Medicaid payment in many states has been too low, thereby restricting access to care. Most physicians see some children who are covered by Medicaid and the Children’s Health Insurance Program (CHIP), although many of them limit their public caseloads. This is not surprising, given the programs pay physicians poorly – on average, Medicaid payment is 72% of Medicare payment and only 64% of average private fees. While many more children are covered with some form of insurance thanks to Medicaid and CHIP, legitimate questions remain to whether this coverage has resulted in those children accessing care with a pediatrician. AAP survey data shows that although Medicaid and CHIP enrollment reached 54% of the total U.S. infant and child population in 2010 (up from 32% in 2000 according to CMS data), pediatricians’ combined Medicaid and CHIP caseload increased only 3 percentage points to an average of 36% over the last decade. While this gap may in part be explained by adult primary care physicians assuming care of the increased numbers of adolescents and young adults provided coverage under Medicaid and CHIP expansion, new survey data suggests low payment to be a key factor contributing to this gap.
The ACA’s Medicaid payment provision attempts to address this access issue, investing as much as $13 billion to raise Medicaid rates. Pediatricians, internal medicine physicians and family medicine physicians are eligible for the increase. Specifically, pediatricians and pediatric subspecialists recognized by the American Board of Pediatrics, the American Board of Physician Specialties or American Osteopathic Association and their relevant subspecialty boards are eligible to receive the higher payments. Other physicians may qualify without board certification if other requirements are met.
The final rule implementing this payment increase was released in November 2012. States had until March 31 to submit implementation plans to the federal government, and every state and the District of Columbia reportedly met this deadline. States will be paying at the increased rates retroactive to January 1; however states may have cutoff dates to enroll for this retroactive payment.
Many states have released self-attestation forms for physicians to sign and to submit to state Medicaid programs, indicating eligibility for the payment increase. The Academy is making these state Medicaid notices and self-attestation forms available on its website . While some states have not released notices or self-attestation forms, every state eventually must have a process for attesting eligibility for the increase in payment. The Academy urges all eligible pediatricians to enroll for this payment increase now or as possible in their state.
The Academy will be seeking to extend the Medicaid payment increase past 2014 and hopes to demonstrate to Congress and the federal government that the payment increase has improved access to care for children across the country. The ACA Medicaid payment increase is a remarkable investment in primary care. This payment increase will strengthen the Medicaid program as pediatricians and other physicians provide children and their families with a medical home financed by Medicaid.
(Editor’s Note: Guest blog posts are solely the opinions of the author.)
