State Has No Plans To Maintain Rate Increase for Medi-Cal Physicians

California officials do not have plans to maintain a recently expired federal incentive program used to encourage physicians to treat Medi-Cal beneficiaries, the Los Angeles Times reports.

Medi-Cal is California's Medicaid program.

Background

Under the Affordable Care Act, the "Medicaid fee bump" program allotted more than $5 billion in federal funding to bring primary care reimbursement rates in line with those under Medicare.

According to the Times, California has one of the lowest Medicaid reimbursement rates in the U.S. Specifically, data from the California Medical Association show that:

• Medicare in April 2014 paid $45.69 for a traditional office visit for a returning patient; and
• Medicaid in April 2014 paid a standard rate of $18.10 for a traditional office visit for a returning patient.

The two-year Medicaid federal rate increase expired with the start of 2015.

According to California Department of Health Care Services spokesperson Anthony Cava, it would cost $1.8 billion annually to maintain the rate increases -- $700 million of which would come from the state.

Effect of Rate Program Unclear

An Urban Institute analysis estimated that the expiration of the fee bump would result in a 58.8% drop in payments for California doctors.

However, Anthony Wright, executive director of Health Access California, said, "People didn't see the [original] increases until months and months after the fact," adding that the program was not implemented well.

In addition, the Urban Institute analysis stated that it is "unclear whether the increase ... has had an effect on the number of physicians accepting Medicaid or the number of Medicaid patients that physicians are willing to see."

According to the Times, advocates say the sate lacks such data. California Medical Association spokesperson Molly Weedn said, "Nobody knows how many physicians are out there seeing new Medi-Cal patients."

Meanwhile, Wright and Christopher Perrone of the California HealthCare Foundation -- which publishes California Healthline -- said that the effects of the rate increases could have been weakened by the high number of physicians working under managed-care plans, which pay doctors a flat rate for patient care. According to the DHCS, about 9 million of the 11.3 million Medi-Cal beneficiaries are enrolled in managed-care plans.

Further, Del Morris, president of the California Academy of Family Physicians, said the program "got mixed into a lot of uncertainty about whether doctors should or should not participate in caring for those patients who were newly insured," adding, "Two years is a pretty short time to change the patterns of your practice" (Brown, Los Angeles Times, 12/31/14).