While Medicaid fees vary by state, they are generally far below Medicare and private plans. The change, which will cost $11 billion and will be paid for by the federal government, means a 64 percent average pay increase, according to an Urban Institute analysis of the 2010 rates.
But implementing the raise is not simple.
“The higher rate sounds great and was used by the Obama administration to sell the law, but the devil is in the details and we don’t yet have the details to go out and recruit doctors,” said J. Mario Molina, chief executive of Molina Healthcare, one of the nation’s largest Medicaid managed-care health plans with 1.8 million members.
With two months to go, doctors, state officials and Medicaid managed-care plans say there are numerous details still to be worked out.
Adding to the uncertainty is that the Obama administration has not issued final rules for the pay hike and most industry officials don’t expect one until after Election Day. In addition, some states have been hesitant to promote the provision because Republican presidential candidate Mitt Romney has vowed to repeal the health-care law if he is elected.
Among the unfinished operational details cited:
●It’s not completely clear which doctors can get the higher pay. Traditional primary-care doctors, such as family physicians, internists and pediatricians, are assumed to be covered. But some specialists, such as pediatric cardiologists, also could be eligible if they provide a certain amount of primary care, according to a preliminary regulation released by the Department of Health and Human Services in May. There is also come confusion about which services are covered under the pay raise. The regulation said the raise will apply to “evaluation and management” of patients, not procedures or diagnostic testing.
●Medicaid managed-care plans, which today enroll about half of the 60 million Medicaid recipients, are unsure how the additional compensation will be passed on to them and how they will compensate doctors who are paid a flat or capitated monthly fee.
●The federal government hasn’t published its Medicare rates for 2013, so states say they can’t tell doctors what the increases will be for Medicaid.
●Doctors are worried that there is no deadline on when states have to reimburse them at the higher rates.
The confusion could undermine the goal of attracting more doctors to treat patients on Medicaid, which under the health-care law could gain as many as 17 million enrollees starting in 2014, some experts say.
“This has tremendous implications for increasing access to primary care, especially in states like Florida and California, where Medicaid rates are very low, but only if it can be implemented properly and relatively soon,” Molina said.