Medicaid Primary Care Incentives Delayed

Implementation of an Affordable Care Act (ACA) provision to increase payments to primary care physicians who treat Medicaid patients continues to be delayed.

The program slated to take effect on Jan. 1, 2013 will increase Medicaid payments to primary care physicians to the same level that Medicare pays for these same services.

While Medicaid fees vary by state, they are generally far below those paid by Medicare and private plans. The change means an average 73% pay increase nationally, according to a 2012 study by the Kaiser Family Foundation.

The Centers for Medicare and Medicaid Services (CMS) noted that once the agency approves a state's amendment to Medicaid payment, physicians will be able to receive the increase in payments retroactively to Jan. 1 without any resubmission of claims needed. States had until March 31 to submit their changes to CMS, after which the agency could take up to 90 days to review and approve them. It could therefore be early June before eligible physicians and practitioners receive any of the higher payments.

Additional information regarding physician self-attestation to qualify for increased payments from each state is expected in the coming months.


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