Starting This Year, Health Care Providers Will Be Short Changed in Medicaid Reimbursements

Thursday, January 29, 2015
Here's a situation: If it costs a physician one dollar to care for a patient, and he/she is only getting 60 cents in reimbursements, the physician is actually paying to take care of a patient.

This hypothetical situation begs the question: Why would physicians agree to treat Medicaid patients?

Treating Medicaid patients has never been a money maker for physicians. However, for the past two years, Medicaid programs have been required to reimburse primary care providers at Medicare levels, which is typically higher. The rate increase was part of the Affordable Care Act (ACA) as an incentive for providers to participate in Medicaid. However, that rate increase expired December 31, 2014. So, what's next for Medicaid reimbursements and physicians accepting Medicaid?

What Happened to the Medicaid Incentive?

According to Bloomberg News, the ACA incentive only covered the higher Medicaid reimbursement rates for 2013 and 2014. The rate increase applied to primary care services delivered by physicians with a specialty designation of family medicine, general internal medicine or pediatric medicine.

President Obama's proposed 2015 budget would have continued the higher payments, but that provision never made it into the $1.1 trillion spending bill passed by Congress. As a result, reimbursement levels will drop to 2012 levels starting in January 2015. On average, primary care reimbursement rates are expected to decline 42 percent.

Click here to read the entire article from Bloomberg.

Looking at Reimbursements for 2015.

Some states are trying to fill the current payment gap with their own money. A Kaiser Family Foundation report found that 15 states were planning on extending the Medicaid payments in some form through 2015. There are 23 states that do not plan to continue the increased reimbursements. To review the entire Kaiser report, click here.

In January 2015, a federal judge ruled that Florida was violating the federal Medicaid law by not paying enough reimbursement money to doctors and dentists to ensure adequate access to care for patients. The Florida case is the latest effort to get federal judges to force states to increase Medicaid provider payment rates for the state and federal program that covers about 70 million low-income Americans. In the past, similar cases have been filed in numerous states, including California, Illinois, Massachusetts, Oklahoma, Texas and the District of Columbia– with many resulting in higher pay.

Poor reimbursement rates have historically led many providers to decline participation in Medicaid, which has had a negative impact on physicians willing to accept beneficiaries. Federal law mandates that the Medicaid program must reimburse health care providers enough to ensure patients have accessible care. This will surely be a hot topic to watch throughout 2015.


With the reduction in Medicaid reimbursement rates will you stop taking new Medicaid patients at your practice? Do you foresee dropping any Medicaid patients due to the rate decrease? Please leave any thoughtful comments below.

Don't Wait Until It's Too Late; Consult with a Health Law Attorney Experienced in Medicare and Medicaid Issues Now.
The attorneys of The Health Law Firm represent healthcare providers in Medicare audits, ZPIC audits and RAC audits throughout Florida and across the U.S. They also represent physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals and other healthcare providers and institutions in Medicare and Medicaid investigations, audits, recovery actions and termination from the Medicare or Medicaid Program.
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Tozzi, John. "Doctors Will Get Less Money for Treating Medicaid Patients Starting in January." Bloomberg. (December 18, 2014). From:

Millman, Jason. "Obamacare Paradox: Medicaid Expanding, But Doctors Are Facing a Huge Pay Cut." Washington Post. (December 10, 2014). From:

Snyder, Laura, Paradise, Julia, and Rudowitz, Robin. "The ACA Primary Care Increase: State Plans for SFY 2015." Kaiser Family Foundation. (October 28, 2014). From:

About the Author: Lance O. Leider is an attorney with The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area.  The Health Law Firm, 1101 Douglas Avenue, Altamonte Springs, Florida 32714, Phone:  (407) 331-6620.

Keywords: Medicaid, medicaid payments, decreased Medicaid payments, Medicaid reimbursement, Medicaid revenue, physician, doctor, primary care doctor, medical practice, physician's practice, reimbursement rate, Affordable Care Act, ACA, Centers for Medicare and Medicaid Services, CMS, federal subsidies, treating Medicaid patients, Medicaid defense attorney, Medicaid defense lawyer, health law firm, defense attorney, defense lawyer, The Health Law Firm reviews

The Health Law Firm" is a registered fictitious business name of George F. Indest III, P.A. - The Health Law Firm, a Florida professional service corporation, since 1999.
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Lance O. Leider, J.D., The Health Law Firm 1/29/2015

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