A delay by the state in boosting Medicaid payments to physicians is “inexcusable” and could hinder access to health care for some of Georgia’s neediest residents, doctor groups say.
The increases — called for by the Affordable Care Act — were supposed to start Jan. 1 of this year, but state health officials say Georgia doctors won’t see those extra dollars until November.
That doesn’t sit well with four physician organizations, whose leaders want the state to solve the problems causing the delay more rapidly.
“Failing to take this action would suggest that the state doesn’t view the issue as a priority — which would only exacerbate the exodus of physicians from the Medicaid program,” the groups wrote in a letter to the state Medicaid chief this week.
While many states have already gone to the higher payment plan, Georgia’s transition has been slowed by technical issues.
The state is working with a contractor to make sure the “financial payment and accounting for the add-on payments” can withstand federal audits, according to a statement from the Georgia Department of Community Health.
The department “will continue to openly communicate with providers about the status of this project and continue to make this project a priority,” it stated.
Under the health care law, primary care doctors were supposed to begin receiving higher Medicaid payments in 2013 and 2014 — fully paid for by the federal government. The hike is an incentive for physicians to accept more Medicaid patients.
Under the plan, Medicaid payments to doctors across the nation would rise by 73 percent on average in 2013, according to estimates by the nonprofit Kaiser Family Foundation. The government health program for the poor pays less than private insurance or Medicare and often isn’t enough to cover the actual cost of care.
It’s difficult for primary care doctors who see a lot of Medicaid patients, especially in rural areas, to make enough money to keep their doors open, said Dr. Bob Wiskind, president of the Georgia chapter of the American Academy of Pediatrics.
“At best, it’s break even and in many cases it’s a loss,” Wiskind said. The increased payments were “a chance for practices to dig out of an economic hole.”
Wiskind signed the letter to the state, along with leaders of the Medical Association of Georgia, the Georgia Academy of Family Physicians and the Georgia chapter of the American College of Physicians.
The increased payments will raise Medicaid payments to the higher rate Medicare pays for services. For example, a pediatrician may typically get $45 or $50 from Medicaid for seeing a child with an ear infection or cold. The higher rate would pay $70 to $75 for the same service, Wiskind said. Once begun, the payments will be retroactive to Jan. 1, 2013.
“It is very disappointing to the physicians,” said Donald Palmisano, executive director of the Medical Association of Georgia.
Georgia doctors haven’t seen an increase in Medicaid payments in more than a decade, Palmisano said. He added that there’s been a 15 percent drop in doctors participating in Medicaid since 2009.
Nearly every state is expected to have begun increased payments by the end of the summer, Wiskind said.
Doctors groups note that the state’s contractor, HP Enterprise Services, also helps oversee Medicaid payments in states where doctors are already seeing increases.
“The implication is that Medicaid patients and physicians simply aren’t a priority in Georgia,” it states.
The changes needed are significant and require thorough testing before being implemented, HP said in a statement to the Atlanta Journal-Constitution.
“Because quality of patient care is the top priority, HP is working closely with (the state) to ensure the integrity of the financial payment and accounting system,” the company stated.
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