Medicaid Primary Care Physician Payment Increase

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June 2013

This June 2013 report chapter on Medicaid primary care physician payment focuses on a specific provision of the Patient Protection and Affordable Care Act (ACA, P.L. 111-148, as amended) that became effective in January 2013: increasing Medicaid fees to Medicare payment levels for primary care services provided by primary care physicians.

The provision is effective for 2013 and 2014 with the federal government paying 100 percent of the costs of the difference in fees. To better understand how it is being implemented by state Medicaid programs and its possible impact on beneficiary access and provider participation, MACPAC examined the relevant research literature and conducted interviews with states, providers, and other key stakeholders. Although early in the implementation process, the feedback we received highlights the challenges of implementing this provision and the need for broader investigation into various options to address access gaps in Medicaid. Read more about the ACA’s payment increase for primary care physicians.

Publication Type: Reports to Congress

From: June 2013 Report to the Congress on Medicaid and CHIP

Tags: access, Affordable Care Act, capitation, fee for service, fee schedules, managed care, payment, physician fees, physician services, physicians, primary care, primary care physicians, provider participation