Drop in Medicaid pay hurts Georgia doctors

Family doctors and pediatricians across Georgia will lose out on tens of millions of dollars aimed at helping them care for the poor unless state lawmakers take action in the coming weeks.

For the past couple of years, primary care doctors have received a bump in their Medicaid reimbursement rates as part of the Affordable Care Act’s aim of improving access to health care for millions of low-income Americans. The goal: encourage more doctors to see Medicaid patients by paying them more.

The federal government promised to fully fund the program through the end of 2014; states could then decide whether to extend the pay bump using their own money. Sixteen states, including Mississippi, South Carolina and Alabama, have maintained the increased reimbursement rates, according to the Washington, D.C.-based Urban Institute. Georgia has not.

“I do feel like we are really about to enter a crisis,” said Dr. Melinda Willingham with Decatur Pediatric Group. “I’d like to be able to see everybody, to treat everyone, regardless of their financial situation. It is very difficult to continue to do that.”

Pediatricians are particularly concerned about the drop in pay because nearly 43 percent of Georgia’s children were on Medicaid in 2014, according to the Georgia chapter of the American Academy of Pediatrics. Without increased payments, some practices, particularly those with a high Medicaid patient base, could have to close their doors, some doctors say.

“I have some patients who drive an hour here and an hour to get back,” said Dr. Michelle Zeanah of Statesboro in Bulloch County. Like many doctors, she said her costs of doing business continue to increase while her pay has remained steady for seven years. Some months, she doesn’t pay herself so she can pay her staff.

“Who wants to come to a state where you have to practice like that?” she said. “This is causing residents and doctors to go to other states where they can make a living. This doesn’t just hurt the poor; it hurts everybody.”

The state needs to maintain at least a portion of the increase, said state Sen. Renee Unterman, who heads the Senate Health and Human Services Committee. She plans to hold a hearing on Feb. 27 to discuss the issue.

“We’re not just talking about poor people here. We’re talking about insurance holders who won’t be able to find doctors in their county because the doctors will have left,” Unterman said.

State officials have said, however, that Georgia can’t afford to maintain the higher pay.

Doing so would cost more than $90 million for the remainder of fiscal 2015 and the following year, according to the state Department of Community Health. The program currently covers nearly 1.8 million mostly low-income children, pregnant mothers, the elderly and the disabled.

Gov. Nathan Deal is working with lawmakers to find solutions, said spokesman Brian Robinson, adding the governor doesn’t comment on pending legislation.

“This is a prime example of how Obamacare is forcing significant new costs onto the state,” Robinson said. “We know Medicaid reimbursement levels are often below the cost of care for providers, and we know what pressures that puts on them from a business perspective.”

Doctors and hospitals have long lost money treating patients with Medicaid because the government health program pays far less than the actual cost of care. Before the pay bump, Medicaid rates remained stagnant for more than a decade, while the cost of doing business for doctors continued to rise.

Now, unless the Legislature steps in, reimbursement rates will drop by more than a third back to those insufficient levels, doctors say. That could force doctors not only to stop taking new Medicaid patients but to close up practice altogether, they argue.

The increase raised Medicaid rates to the level of Medicare, the government health program for Americans age 65 and older. But Medicare still pays less than what private insurance does.

“Medicare barely covers the cost of care, so it’s not like we’re asking to be reimbursed at a high rate,” said Dr. Thomas Bat, a primary care physician in north Atlanta. “We’re asking them to raise rates to a minimum rate.”

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This article is a collaboration of The Atlanta Journal-Constitution and Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.