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Originally published Monday, February 3, 2014 at 5:18 PM

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Guest: Compensate doctors fairly for Medicaid patients

Few providers accept Medicaid paitents because reimbursement rates don’t come close to covering the costs of care, writes guest columnist Dale Reisner.

Special to The Times

No comments have been posted to this article.


Having health coverage is supposed to be the clear link to getting health care. But for many in Washington, that’s not the case. People with low incomes who have Medicaid health coverage often can’t find a provider who will see them. Their coverage does not open doors and connect them to care.

Fortunately, there is a clear solution to this problem, and our state Legislature can address it now by extending an increase in Medicaid payment rates that the federal government recently funded.

The reason there are so few providers who accept Medicaid patients is that reimbursement rates don’t even come close to covering their costs to provide care.

Many practices, in order to keep their business afloat, must limit the number of Medicaid patients they can treat. Historically, Medicaid rates have been extremely low, covering just 66 percent of Medicare payment rates. Those numbers don’t add up to a sustainable practice for most primary-care providers. Fair Medicaid compensation for physicians would help change that.

Unfair rates create a shortage of physicians for Medicaid patients. A significant portion of Washington’s population is affected by this. Medicaid serves more than 1 million low-income residents, including 432,000 children. That’s 42 percent of Washington children. In rural areas, lack of Medicaid providers leaves many enrollees with serious barriers to finding and getting care.

For a family in a rural community, it could be an hour’s drive to a provider who takes Medicaid patients, so getting your children their immunizations and yearly flu shots becomes a major challenge.

For a parent holding down two part-time jobs to make ends meet, finding a physician who sees Medicaid patients during your off hours may prove difficult — forcing you to choose between putting food on the table and providing preventive health care to your children. When that non-urgent care is postponed, it can lead to preventable problems that end up being treated in the emergency room, driving up health care costs for everyone.

And this conundrum can be expected to grow with the expansion of Medicaid this year, which will create increased demand for care across the state. It is estimated that the U.S. will face a shortage of more than 52,000 primary-care physicians by 2025.

The federal government sought to address this problem with funding through the Affordable Care Act to provide fair Medicaid compensation for primary-care and preventive-health services, bringing rates up to Medicare levels. But its 100 percent funding is temporary, covering two years through the end of 2014. Washington state must now contribute to funding that rate increase, with matching dollars from the federal government.

There is urgency for the state Legislature to address this in the current supplemental budget. Because Washington state’s fiscal year doesn’t begin until July, and federal funding ends in December, there is a six-month gap needing immediate attention before the next biennial budget.

Closing this funding gap will help ensure that patients won’t be dropped by their providers and lose continuity of care, which is especially critical for people with chronic conditions such as diabetes. And it will entice the providers who have yet to commit to Medicaid patients because of funding uncertainty to open their doors sooner.

Even though there is a $24 million budget amount attached to this request, it is an investment that will ultimately lower state health-care costs. Without access to quality primary care, preventable emergency room visits increase while health outcomes worsen, costing the state money, productivity and lives. And physician fees represent just a fraction of total Medicaid expenditures in Washington — currently less than 6 percent.

Fair Medicaid compensation connects the dots between Medicaid coverage and access to care for low-income Washingtonians. It’s up to our state Legislature to make it happen.

Dale Reisner is the president of the Washington State Medical Association and is a doctor specializing in maternal fetal medicine in Seattle.

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