Payment rates to primary care providers who see Medicaid patients rose dramatically in 2013, and so did the number of providers participating in the program.
In December, there were 3,256 primary care providers in the program, a figure that includes doctors, advanced practice registered nurses and physician assistants. That was up from 2,370 in January 2013, a 37 percent increase. And it’s more than double the number of primary care providers participating in Medicaid in January 2012: 1,622.
The primary care payment increase, which took effect in July 2013 but was retroactive to the start of the year, was required as part of the federal health law commonly known as Obamacare, and funded by the federal government.
But the federal funds are slated to expire Dec. 31. In his budget plan released Thursday, Gov. Dannel P. Malloy proposed using state funds to continue the higher payment rates, something that’s projected to cost the state $36.2 million per year. (In the coming fiscal year, the state’s cost would be half that because the federal funds will still be available for the first six months.)
For a primary care doctor, the rate bump meant receiving $123.53 for seeing a new Medicaid patient, up from $66.40. The payment rate for an urgent care visit rose from $42.93 to $82.98.
While the rate increases have been significant, they’re not the only change in the Medicaid program in the past two years. Others include streamlining the enrollment process for providers and paying claims on a two-week cycle, far faster than in the past. In addition, the medical side of the Medicaid program is now administered by one organization, Community Health Network, rather than three managed care companies that had in the past contracted separately with providers.
Making sure patients can find a health care provider to treat them has long been a challenge in Medicaid, an issue that some people feared would become more acute as the state’s Medicaid program adds thousands of members who are newly eligible under Obamacare. The additional primary care doctors could help ease access, although advocates have noted that it doesn’t help with another challenge -- getting specialists to see Medicaid patients.
Here's how many providers participated in Medicaid at three points in time, by type: