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Medicaid Physician Payments Vary Widely Among States

Armen Hareyan's picture

Medicaid Physician Payments

Medicaid payments to primary care physicians vary widely amongstates, while Medicare physician payments are more similar across thecountry, according to a report released Wednesday by Public Citizen, the Philadelphia Inquirer reports (Burling, Philadelphia Inquirer,9/6). For the report, Public Citizen analyzed 2003 Medicaidreimbursements in 10 states that had the lowest and highest rates.States with the highest rates were Alaska, Arizona, Arkansas, Delaware,North Carolina and Wyoming (Solomont, New York Sun, 9/6).

States with the lowest rates were New Jersey, New York, Pennsylvania and Rhode Island, as well as Washington, D.C. (Philadelphia Inquirer,9/6). The report found significant differences in state Medicaidreimbursement rates. For example, in New York, Medicaid reimbursesphysicians $20 for an hour-long visit with an established patient,while higher-paying states, on average, pay $49.20 for a 15-minutevisit or $157.92 for an hour-long appointment (New York Sun, 9/6).

AnnetteRamirez de Arellano, a Public Citizen researcher and co-author of thereport, said the lowest-paying states tended to have broadereligibility requirements and more generous benefits than states withthe highest reimbursements (Philadelphia Inquirer, 9/6). According to Sidney Wolfe, director of Public Citizen's Health Research Group,the differences between states' Medicaid reimbursements suggest thatMedicaid beneficiaries could receive lower-tier care in states with lowpayments.

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The report also found substantial differencesbetween average Medicaid reimbursement rates, which are set by states,and Medicare reimbursement rates set by the federal government. Forexample, in New Jersey, Medicare reimburses physicians $65.65 for a15-minute office visit, while Medicaid pays $20.30, according to thereport (Layton, Bergen Record,9/6). In a comparison of 11 procedures, New Jersey Medicaidreimbursements were less than one-third of Medicare's andPennsylvania's were 42% less.


Ramirezde Arellano said, "There are a number of consequences," adding, "One isthat a lot of practitioners decide it's not worth their while to seeMedicaid patients" (Philadelphia Inquirer, 9/6).

"Aslong as Medicaid fee schedules shortchange providers, the program andits clientele will be considered less worthy, and access to care willbe restricted for the poorest, neediest Americans," Wolfe said (Bergen Record, 9/6).

Stacey Witalec, a Pennsylvania Department of Welfare spokesperson, said, "We do not consider [the gap between Medicaid and Medicare rates] to be a major problem" (Philadelphia Inquirer, 9/6).

Suzanne Esterman, spokesperson for the New Jersey Department of Human Services,said, "We've known our reimbursement rates needed to be improved. We'regrateful the governor put in additional funds" to increase rates forpediatricians "so we can begin to address the issue" (Bergen Record, 9/6).

Reprinted with permission from kaisernetwork.org. Youcan view the entire Kaiser DailyHealth Policy Report, search the archives, and sign up for email deliveryat kaisernetwork.org/email. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, afree service of The Henry J. Kaiser Family Foundation.