Lawmakers Must Raise Medicaid Reimbursement

This article was published in The Columbian on March 25, 2015 during a legislative session when the WSMA and others were trying to prevent the ACA increases in primary care physician fees from sunsetting. To this day, we continue to under-fund the most important cost-containment mechanism inherent in the healthcare system.



Nearly 31,000 more people in Clark County have gained health insurance through Medicaid over the past year. When uninsured, many patients forgo basic care and can wind up in the emergency room when their health conditions can no longer be ignored — a very expensive and inefficient way to deliver health care.

Now, insurance coverage is opening doors to see a primary care doctor for preventive care and management of chronic conditions — in theory. In reality, many doors remain closed because low Medicaid rates mean many providers aren’t able to accept more Medicaid patients.

Medicaid expansion was a critical first step in covering more people in our state. But now it’s up to our state Legislature to take the necessary second step to ensure that coverage translates to access to actual health care — funding a fair reimbursement rate for Medicaid primary care providers.

Right now the reimbursement rate to care for Medicaid patients is woefully inadequate, and it is a key reason why some providers don’t take Medicaid patients. In an attempt to address this problem, the federal government temporarily raised Medicaid rates to pay primary care services at the same rate as Medicare. That temporary rate increase expired in December.

For the state, it’s a simple financial equation. Without access to quality primary care, preventable emergency room visits increase while health outcomes worsen, costing the state money, productivity and lives. Several studies in Washington state demonstrate a significant reduction in emergency department visits and hospitalizations as the result of increased primary care utilization, particularly when integrated with mental health care.

Positive effects

We also know that maintaining fair Medicaid reimbursement rates improves patients’ access to primary care. A recent study looked at the effect of enhanced Medicaid payment rates on primary care access in 10 states (not including Washington). It showed that the availability of primary care appointments for new patients increased by 7.7 percentage points in states with the enhanced rates.

A recent survey in this state showed similar impact. Just over one-third of primary care physicians in smaller practices indicated increased willingness to accept new or continue providing care for current Medicaid patients as a result of the federal government’s temporary Medicaid payment increase.

Providers with larger numbers of Medicaid patients reported the greatest impact of the payment increase, indicating that it had made them more willing to accept new Medicaid patients and to continue providing care for current Medicaid patients.

The loss of the rate increase will reverse these gains. The survey found that nearly three-quarters of primary care physicians not in large health care organizations would limit or reduce the number of Medicaid patients they see when the payment increase ends.

The plan has gotten positive feedback from local legislators. Let’s hope that translates to commitment when budget negotiations get tough. The ability for thousands in Clark County to use their Medicaid coverage and get the care they need depends on it.