Currently, Medicaid primary care services are being paid at Medicare levels. This federally funded enhanced payment allows physicians to serve more Medicaid patients. However, the provision expires on December 31, 2014 unless Congress votes to extend it.
In 2013 and 2014, the higher Medicaid rates apply to primary care services furnished by a physician with a specialty designation of family medicine, general internal medicine, or pediatric medicine. Higher payments are also allowed for subspecialists related to those specialty categories as recognized by the American Board of Medical Specialties, American Osteopathic Association, and the American Board of Physician Specialties.
Physicians who are in those designated specialties but not Board certified (are Board eligible) can also qualify if at least 60 percent of the codes billed by the physician are for specified evaluation and management (E&M) codes and vaccine administration codes. Codes eligible for the higher payment are E&M codes 99201 through 99499 and vaccine administration codes. This includes codes within the specified range that are not currently covered by Medicare.
UCAOA is urging Congress to extend the Medicaid payment increase for at least two more years, but we need your help!
Please take a moment to contact your members of Congress and ask them to pass legislation before the end of this year that would extend the Medicaid payment increase.
Contacting Your Member of Congress
You can contact your senators and representative by phone or email.
Phone: Call the U.S. Capitol Switchboard (202-224-3121) and ask to be connected to your senators or representative. (Note: You must know the name of your lawmakers to be connected to the appropriate office). Once connected, ask to speak with or leave a message for the Health Legislative Assistant.
Email: Most congressional offices have a mechanism on their Web pages for sending an email. Simply Google your senator or representative’s name to find his/her official congressional Web page, or go to:
The following is a sample email that can be personalized to maximize its effectiveness.
Sample Email or Letter
As an urgent care provider, I respectfully ask that you act before the end of this year to prevent cuts to federal payments for primary care services in the Medicaid program.
Currently, certain primary care physicians are eligible to receive Medicaid payments at Medicare levels for specified primary care services. Without congressional action, this “Medicaid payment parity” policy will expire and providers who care for Medicaid patients will experience significant payment cuts, creating a disincentive to care for this patient population.
State interviews conducted in 2012-2013 by the Medicaid and CHIP Payment and Access Commission found that several states are unlikely to continue “Medicaid payment parity” without federal support. States are also concerned that if the payment parity policy is discontinued, it may negatively affect efforts to recruit physicians to the Medicaid program. In 2008, prior to the implementation of the parity policy, Medicaid payment rates were on average 66 percent of Medicare rates. Just as more Americans are being covered by Medicaid, a return to these insufficient payment rates could create a situation of coverage without access for this vulnerable patient population.
I ask you to help ensure adequate access to primary care for those who rely on Medicaid by extending payment parity before the end of the 113rd Congress.