Study: Medicaid Reimbursement Increases Under ACA Boost Access

A temporary increase in reimbursements under the Affordable Care Act for primary care physicians who treat Medicaid beneficiaries resulted in easier access to appointments, according to a study published Wednesday in the New England Journal of Medicine, Modern Healthcare reports (Dickson, Modern Healthcare, 1/21).

To determine appointment availability, researchers acted as patients with either Medicaid or private coverage and called providers to try to set up an appointment. The researchers contacted providers in 10 states during two time periods -- November 2012 through March 2013, before the reimbursement increase, and May 2014 to July 2014, after the increase (Brown, "The Gupta Guide," MedPage Today, 1/21). They then compared appointment availability.

The researchers found that appointment availability for Medicaid beneficiaries increased from 58.7% during the first period to 66.4% during the second period (Modern Healthcare, 1/21). By contrast, those with private coverage did not experience a significant change in appointment availability.

Further, the states that offered the greatest reimbursement increases generally saw the largest increase in appointment availability, according to "The Gupta Guide" ("The Gupta Guide," MedPage Today, 1/21).

Trend Could Reverse; Some States Continue Bump

Reimbursement increases expired Dec. 31, 2014, which could reverse the access gains for Medicaid beneficiaries, according to Modern Healthcare.

However, according to a Kaiser Family Foundation report published last fall, some states intend to maintain the rate increases on their own. For example:

• 15 states have indicated they will continue the rate increase partially or fully; and
• 14 states have indicated they are still determining the increases' effects on providers.

Report Could Convince Lawmakers To Continue Increase

Meanwhile, the report could convince federal lawmakers to continue the reimbursement increase. According to American Academy of Family Physicians President Robert Wergin, providers previously had lobbied Congress to extend the increase but had been unsuccessful because they lacked statistically valid data to support their position.

Study lead author Daniel Polsky, of the Leonard Davis Institute of Health Economics at the University of Pennsylvania, said, "I could see the reluctance to maintain the Medicaid pay bump without clear evidence that it was working," adding, "But now we have the evidence" (Modern Healthcare, 1/21).