Medicaid ob-gyn fee cuts worry doctors, advocates

The state’s Medicaid program is cutting payment rates for doctors who provide pregnancy care, perform deliveries and women’s preventive services, leading medical groups and advocates to worry that it could become harder for low-income pregnant women to find doctors to treat them.

The cuts in ob-gyn payment rates come after a significant growth in the number of people covered by Medicaid, noted a group of medical organizations and hospital officials, who warned in a letter to state social service officials that the cuts could lead to significant problems.

“These draconian cuts will have an immediate and irreversible impact on access to care for expectant mothers in the Medicaid program in Connecticut,” the Connecticut State Medical Society, American Congress of Obstetricians and Gynecologists, Connecticut Chapter of the American Congress of Obstetricians and Gynecologists, Connecticut Academy of Family Physicians, Yale Medical Group, Women’s Health Connecticut, and several hospital leaders wrote to Social Services Commissioner Roderick L. Bremby and Medicaid director Kate McEvoy.

If physicians stop accepting Medicaid because of the reduced rates, they warned, Medicaid patients could have to travel long distances to seek care, and many pregnant women — who require frequent care, particularly in the third trimester — wouldn’t be able to do so.

Medicaid covers about 40 percent of all births in Connecticut, including 60 to 70 percent of births in the state’s largest cities, said Mary Alice Lee, a senior policy fellow at Connecticut Voices for Children, who analyzes Medicaid data and serves on the council that oversees the program.

“The Medicaid program is arguably the most important maternal and child health program in Connecticut,” she said. “So any change in the Medicaid program is significant, and we need to pay attention to it.”

Research indicates that fees are only one of several factors that influence whether physicians participate in Medicaid, Lee said. But she said she’s concerned about the impact any cuts to the fee schedule could have on physician participation, especially in maternal and child health.

The cuts, which took effect April 1, include reduced payments to ob-gyns for certain preventive care, imaging and deliveries. The payment rates for obstetrical care, for example, fell 23 percent, from $2,900 to $2,252. A doctor performing a cesarean delivery will now be paid $1,393, down 13 percent, while a preventive care office visit for a woman aged 18 to 39 now pays $123, down from $187.

Matthew Katz, CEO of the Connecticut State Medical Society, said that even before the cut, Medicaid’s obstetric rates were already far below what commercial insurers pay.

Medicare payment rates are often used as a benchmark for Medicaid rates, and Department of Social Services spokesman David Dearborn noted that Connecticut obstetricians have been paid “well over 100 percent” of the comparable Medicare rates, while most other specialists are reimbursed at an average of 57 percent of Medicare rates.

“The rates taking effect April 1 will still be higher than Medicare-level rates,” he said.

Mary Alice Lee

Arielle Levin Becker / The CT Mirror

Mary Alice Lee

While Medicare mainly covers people aged 65 and older, it also provides coverage to some younger people with disabilities.

Dearborn said the cut was “one of a number of difficult measures in the current fiscal environment.” Laboratory fees were also recently reduced significantly, while other providers face rate cuts as part of Gov. Dannel P. Malloy’s proposed budget for the next two fiscal years.

The rate cut is expected to save the state $1 million this year and $6 million in the next fiscal year.

“We do not anticipate that Connecticut doctors will limit access to care for pregnant women,” Dearborn said.

Many women use their ob-gyns as their primary care physicians, and Lee noted that while the state has put money into reimbursement increases for primary care doctors, “ironically, these primary care rates for women are being cut and access to care may be affected.”

It will be critical for the department to monitor provider participation, she said.

“At the very least, if this is a cost-cutting measure that the department feels it cannot avoid, then they must be prepared to monitor the impact of the cuts on provider participation in the program and be able to report back to the Connecticut General Assembly and the Medicaid oversight council on just how access to primary care and access to specialty services during pregnancy and afterwards are affected by the cuts,” Lee said.

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