Medicaid payments rise for child health care

Medicaid payments rise for child health care

Publish date: Jan 3, 2013
By:  Contemporary Pediatrics Staff

Beginning January 1, Medicaid payment rates for pediatricians and physicians who care for children increased to at least those of Medicare for immunizations and primary care.

The final rule comes under the Affordable Care Act (ACA) of 2010, which mandates federal funding for a 2-year increase (calendar years 2013 and 2014) in payments for certain primary care and immunization services for children covered by Medicaid. The policy sets a floor on Medicaid payments that is equal to the Medicare payment level that would apply.

The provision is welcome news for pediatricians and physicians in family medicine and internal medicine who provide checkups, preventive screenings, vaccines, and other primary care services for children. Increased payment rates will significantly raise income for physicians serving Medicaid patients by tens of thousands of dollars, and for many pediatricians the rise will be even larger. The ruling also applies to many pediatric subspecialists who provide primary care.

The new rule also will improve access to care for children of low-income families and for those with special needs.

Pediatricians serve an average of 30% of Medicaid patients, more than other primary care physicians, says the American Academy of Pediatrics (AAP). The academy is encouraging its members to work with their chapters toward health reform in 2014 that will expand the Medicaid program within their states for uninsured adults with incomes below 133% of the federal poverty level. In June 2012, the US Supreme Court gave states the right to choose to expand Medicaid under the ACA.

Thomas McInerny, MD, AAP president, lauded the action. “The payment increase is a historic recognition by the federal government that children in Medicaid should be valued the same as adults in Medicare for identical primary care services, and hopefully will serve as the first step to make the increase a permanent part of the law,” he said.

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