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Medicaid pay raise for doctors? Not here, not yet

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The long-delayed Medicaid pay raise for primary care physicians is expected to begin this summer for almost all states, Kaiser Health News reported Tuesday, quoting a federal agency spokeswoman.

But Georgia won’t be among them.

The projected date for physicians in Georgia to get the pay bump is November, according to the state Medicaid agency.

The Department of Community Health said in an email statement Wednesday to GHN that the increase has been delayed because the agency and vendor HP “are working to ensure the integrity of the financial payment and accounting for the add-on payments to withstand the financial audits that the federal government will conduct.”

The delay has frustrated physician groups, who cite financial pressure on doctors who have a large Medicaid patient base. Georgia physicians have not had a Medicaid pay raise in more than a decade.

Under the health reform law, Medicaid fees for primary care are being increased for two years to the same amount paid under Medicare. The change means an average 73 percent pay increase nationally, according to a Kaiser Family Foundation study.

For a “sick” office visit, the Medicaid pay for a Georgia physician had been projected to rise from about $40 to nearly $70.

“The whole process has been very frustrating,’’ said Dr. Bob Wiskind, an Atlanta pediatrician and president of the Georgia chapter of the American Academy of Pediatrics.

Medicaid in Georgia pays about half of what commercial insurance pays for children’s services, Wiskind said.

“A fee increase was seen as a real lifeline for physicians,’’ helping persuade them to remain in – or join — the Medicaid program, he said. “Georgia is on track to being if not the last state [to implement the pay raise], then in the bottom three.’’

The pay bump will be retroactive to services rendered since Jan. 1, when it was originally intended to begin. The Affordable Care Act required that Medicaid payment for services be raised for family physicians, internists and pediatricians, and for vaccinations.

Low doctor pay from Medicaid has been a major obstacle to access to care in the state. A recent survey of 1,400 physicians in Georgia that showed about half of them do not accept new Medicaid or PeachCare patients.

The raise will buoy the financial situations for many physicians who treat a large number of Medicaid patients.

“It will help tremendously financially,’’ Dr. Jaquelin Gotlieb told GHN last year. She and her husband, Dr. Edward Gotlieb, are pediatricians who have practiced as a team in the Stone Mountain area for 36 years. Over that time, the two have seen their percentage of Medicaid patients rise — while the income from their practice drops.

Fay Brown, executive vice president of the Georgia Academy of Family Physicians, said Wednesday that she is concerned about patients’ ongoing access to care. “Doctors are hesitant to fully embrace the Medicaid program until they see the bump in reimbursement,’’ Brown said.

Matt Salo, executive director of the National Association of Medicaid Directors, told Kaiser Health News that states are frustrated about the delay, especially because the provision was designed to improve access for Medicaid recipients. “It’s been slow to roll out . . . and it’ll be gone less than 18 months after it starts,” he said.

Part of the reason for the delay is the difficulty figuring out how to implement it, the article said. Also, the Obama administration did not issue the rules on Medicaid pay until last November.

Many states have set deadlines for doctors to personally attest that they are primary care physicians willing to accept Medicaid patients in order to get the retroactive pay from Jan. 1 onward. Those who miss the deadline will only receive the pay raise once they fill out a form showing they are licensed as a family doctor, pediatrician or internist.

In Georgia, Community Health said it is urging doctors to attest to their eligibility by July 31 to receive their payments retroactive back to Jan. 1.

The pay raise ran into some controversy last year when the idea was not greeted enthusiastically by the Community Health board.

There were expressions of dissatisfaction and a dissenting vote on the raise at a December agency board meeting. The discontent appeared to stem from the pay raise’s link to the federal health reform law, which has survived legal and political challenges but remains unpopular with many Georgians.

For more from Georgia Health News, go to www.georgiahealthnews.com


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