Higher Primary Care Rate Welcome News for California

Earlier this month, CMS made it official: The federal government will pay Medi-Cal primary care physicians in California at the same rate as Medicare in 2013 and 2014.

The higher rate, confirmed by CMS officials on Nov. 2, means more than just paying more to family practice, pediatrics and internal medicine physicians, said Kevin Prindiville, deputy director of the National Senior Citizens Law Center, a national legal advocacy group with an office in Oakland.

“We hope this will improve access,” Prindiville said, “and there aren’t too many things in our market-driven system that can do that.”

The new rate has the added benefit of saving California money, he said, since the federal government is paying for the rate change, but the state will reap the savings from lighter use of public services, from emergency departments to 911 calls, because more people will have access to preventive care.

That’s particularly helpful for seniors, Prindiville said.

“We think it’s a big deal for dual eligibles,” he said. Under the current system, duals sometimes have to pay for 20% of their care because of Medicare/Medi-Cal rules, but now they won’t have to pay that.

“The feds are paying the difference, even though the payment comes from the state,” Prindiville said. “So in this case, the doctor will get pay from two places, but at end of the day they’ll have 100%, which ends up bringing the poor on an equal footing with everyone else. It equalizes the program and it equalizes access, whether people are in managed care or fee-for-service.”

The big concern about the move is that physicians might not commit to taking care of Medi-Cal patients, even at the higher rate, since that rate is only good for two years.

“We hope the providers would be willing to see more patients because of this,” Prindiville said. “The idea for it was advanced by primary care doctors, and we think it does bring down cost by providing better access. So if it does work, we would hope Congress might extend it.”

Prindiville said he thinks physicians would love to get the higher payment, whether it’s for two years or for longer. “Look, even if the statute said it would last forever, everyone knows it could change for any reason,” he said.

“What we do know is that access is related to the rates, so let’s give it a try, and we hope it will work.”

Related Topics

Capitol Desk Medi-Cal Medicare