Most States Not Paying Required Doctors' Medicaid Increases

Just six states and the District of Columbia will use their own money in 2015 to sustain the federal Medicaid pay raise to primary care doctors, which was a key provision of the Affordable Care Act intended to make sure millions of low-income people enrolling in the expanding insurance program have access to a physician.

Interestingly, two of the states extending the pay raise are Alabama and Mississippi -- neither of which expanded Medicaid under the health law. The other states extending the pay raise next year are Colorado, New Mexico, Iowa, and Maryland, according to interviews with state officials and the American Medical Association. Those four states expanded their Medicaid eligibility to cover everyone with incomes less than 138% of the federal poverty level, or about $15,900 for an individual.

Alaska and North Dakota paid primary care doctors in Medicaid the higher rates even before the health law's provision took effect in 2013.

The other 42 states will let the Medicaid pay rates revert back to their 2012 levels.

Under the law, Medicaid fees for primary care increased in 2013 and 2014 to the same amount paid under Medicare. While Medicaid fees vary by state, the change meant an average 73% pay increase nationally, according to a 2012 study by the Kaiser Family Foundation and the Urban Institute. (Kaiser Health News is an editorially independent program of the foundation.)

Nationally, it's unclear whether the higher fees attracted more doctors into Medicaid or made doctors more willing to treat more Medicaid patients. The Obama administration is not collecting any data to show the impact of the higher fees, said a spokeswoman for the Centers for Medicare & Medicaid Services. State Medicaid officials also have not studied the impact.

For years, some states have struggled to attract doctors to Medicaid, largely because of their low pay. About 69% of doctors nationally accept new Medicaid patients, but the rate varies widely across the country, according to a study published in 2012 in the journal Health Affairs. New Jersey had the nation's lowest rate at 40%, while Wyoming had the highest, at 99%, according to a survey of doctors by the CDC.

Physician groups, while pleased with the extra funding, have said for years that the 2-year cap would limit its impact on persuading more doctors to treat Medicaid patients. Still, they worry about what happens when the short-lived pay raise goes away in most states.