Primary care providers accepting Medicaid doubled since 2011

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:

Medicaid primary care providers

More In This Series
Obamacare: Continuing Coverage

Follow The Mirror's coverage of the Affordable Care Act in Connecticut. Find features, explainers and Q&As to better understand how the complex policy changes taking place under Obamacare are supposed to work in theory, and how they're working out in practice.

About Arielle Levin Becker

Arielle Levin Becker was a finalist in 2009 for the prestigious Livingston Award for Young Journalists, a recipient of a Knight Science Journalism Fellowship and the third-place winner in 2013 for an in-depth piece on home caretakers from the National Association of Health Journalists. Arielle previously worked for The Hartford Courant, most recently as its health reporter. She also has covered education and municipal beats for The Courant and for the Home News Tribune of East Brunswick, N.J. She is a 2004 graduate of Yale University.

Comments

comments