District, chapter leaders advocate for Medicaid payment increase
AAP News, October 29, 2014
AAP district and chapter leaders agree that continued collaboration and advocacy by pediatricians is critical to extending the Medicaid payment increase that is set to expire at the end of the year.
Under the Affordable Care Act (ACA), primary care physicians
with specialty designations of pediatric medicine, family medicine
and/or general internal medicine are receiving Medicaid payments
equal to the Medicare rate for certain evaluation and management
and vaccine administration codes. The two-year increase, however,
is set to expire at the end of 2014 if Congress does not act.
Before the increase, pediatricians treating Medicaid patients were
paid on average 70% of what is paid by Medicare. The Medicaid
payment increase has allowed a number of practices to expand their
hours, hire staff and accept new Medicaid patients.
As part of the Academy’s efforts to maintain the payment increase
beyond 2014, chapters are encouraged to reach out to their congressional
delegations to express support for the Ensuring Access to Primary
Care for Women and Children Act (S. 2694), which would
extend the Medicaid payment increase for at least two more years.
A number of chapters also are advocating at the state level to extend
the payment increase using state dollars. To date, nine states have
funding in their budgets to maintain the increased Medicaid payments.
Alabama is among the states utilizing state dollars to fund the payment
increase beyond 2014.
“Unlike other business relationships, the doctor-patient relationship
is not just built over one or two years, but over a lifetime,” said chapter
President Michael J. Ramsey, M.D., FAAP. “With
our state agreeing to continue the Medicaid ‘payment
bump,’ pediatricians and providers are able
to continue to build that relationship, improving
the lives and health of Alabama’s most vulnerable.
The Alabama Chapter is so proud that Alabama
is helping lead the way in this important endeavor
and urges the federal government to follow suit.”
AAP President James M. Perrin, M.D., FAAP,
has said that Medicaid has been critical in helping to reduce the number
of uninsured children to record lows and ensuring that children
have timely access to high-quality, age-appropriate, affordable health
Chapter advocacy makes a difference
The North Carolina Chapter’s advocacy for an extension of the
attestation deadline has resulted in an increase in the number of primary
care physicians who qualified for the Medicaid payment increase,
from approximately 5,000 physicians as of June 20, 2013, to more
than 16,000 physicians on June 20, 2014. That
translates into millions of dollars in payments for
primary care physicians.
“The enhanced payments to pediatricians have
enabled practices in many settings, especially independent
and hospital-based, to expand services
like the hiring of mental health professionals or
to fund other improvements that strengthen the
ability to serve children enrolled in Medicaid,”
said chapter President John W. Rusher, M.D., FAAP. “It has also
allowed practices overhead support to develop and sustain practice
operations for all patients.” The Massachusetts Chapter continues
to work with chapter members and leaders, its
pediatric council, and other chapter committees
to advocate for extension of the Medicaid payment
increase and improved access to Medicaid, the
Children’s Health Insurance Program and other
funding streams to provide health care coverage
for all children.
“We think we will improve access because of
increased rates in primary care services for kids
within Medicaid,” said Peter Rappo, M.D., FAAP, chair of the chapter’s
The Academy continues to advocate for an extension of federal
support for the Medicaid payment increase and remains committed
to ensuring the Medicaid payment increase is fully implemented.
The Academy is working with members on specific issues related to
slow payment by Medicaid managed care organizations and other