Enhanced Medicaid Reimbursement Rates for Primary Care Services

To prepare the primary care workforce for the influx of new Medicaid-eligible patients established through the Affordable Care Act (ACA), this provision increases payment rates for certain primary care services to at least the level of Medicare in 2013 and 2014. The provision, often referred to as the Medicaid Primary Care Pay Parity program was included because primary care physicians, including internal medicine subspecialists who provide primary care, will be particularly affected by the Medicaid expansion since millions of new patients will enter the health care system and many will have complex health care needs. Primary care physicians and subspecialists are not required to participate in Medicaid, and many practices do not accept Medicaid patients because reimbursement rates are relatively low and the administrative barriers are significant. Further, people who are currently eligible for Medicaid but not enrolled will likely enroll in Medicaid coverage to comply with the individual mandate included as part of the ACA, adding more beneficiaries to the program. Many of these new Medicaid patients will be adults who seek care from internists. These increased payment rates apply to all states; independent of the state’s decision regarding participation in the Medicaid expansion opportunity provided through the ACA. 

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