The Medicaid pay raise: Doctors finally got it, but soon may lose it

Dr. Evelyn Johnson examines a patient in her Brunswick office.
Dr. Evelyn Johnson examines a patient in her Brunswick office.

Dr. Samuel Church is among Georgia physicians who received their first pay raise in more than a decade this year for treating Medicaid patients.

The extra money gave a financial boost to Church, a family medicine doctor with a solo practice in the mountain town of Hiawassee.

With the increased reimbursement, he says, “I can cover the [office] overhead and a little more. . . . We’re already operating at narrow profit margins as it is.”

That Medicaid pay increase, though, will disappear in January if the budget recommendation from the Georgia Department of Community Health to the governor and Legislature holds up during the state’s budget process.

The proposal approved by the Community Health board last week for this fiscal year and next did not include what experts estimate as $50 million to $70 million in annual state funding to extend the pay hike for primary care doctors treating Medicaid patients.

Currently, the pay raise is being funded entirely by the federal government, as a provision of the Affordable Care Act, bringing doctors’ pay for Medicaid up to the level of Medicare.

The additional reimbursement, which goes to family physicians, pediatricians and internists, is scheduled to run out at the end of December.

Doctors say if that cutoff happens, Georgia’s poor will find it harder to find a physician to treat them. Roughly 60 percent of Georgia physicians currently accept Medicaid patients.

A spokeswoman for Gov. Nathan Deal, Sasha Dlugolenski, said in an email to GHN on Thursday, “The governor will be developing his budget recommendations throughout the fall and is aware of this issue – one of the early, blatantly obvious examples of Obamacare unloading costs onto the states. This was a short-term Band-Aid to a long-term problem, and now the states are left holding the bag.”

Sen. Judson Hill (R-Marietta) told the AJC that he supports compensating doctors fully for treating Medicare and Medicaid patients. But he told the newspaper that he is opposed to the state “being forced’’ to picking up the entire cost of maintaining the pay increase.

Taking new patients

For Church, going back to the former pay rate would be a big setback.

The area around Hiawassee, in the scenic Blue Ridge Mountains near North Carolina, gets its main revenue from tourism. But the population base is small, and many residents have low incomes. The area has a severe physician shortage, Church says, and roughly 30 percent of his patients are Medicaid beneficiaries.

Dr. Samuel Church with a patient in his Hiawassee practice.
Dr. Samuel Church with a patient in his Hiawassee practice.

“It’s really scary,’’ says Church. “You have to be able to pay staff and overhead” to keep a practice going.

Recently, two physicians moved out of the area, he notes. “I’m the only doctor taking new patients in the community.”

Inadequate payment, Church says, “makes it difficult for new providers to choose service to vulnerable groups, even if their heart is there.”

The federal health law required that the raise be paid for two years, 2013 and 2014.

But the money didn’t arrive till this year. Eligible doctors received the pay hike retroactively, back to Jan. 1, 2013. Delays in the payments occurred in many states, including Georgia, that use managed care in their Medicaid programs.

A Kaiser Family Foundation study estimated in 2012 that the increase in Georgia’s Medicaid payment rate for doctors would be 48 percent.

A handful of states have announced they will continue to pay the higher rate in 2015, out of their own budgets. The six states include Alabama and Mississippi, according to a recent Kaiser Health News article.

The Medical Association of Georgia says it’s studying the impact of the loss of the extra pay in terms of physician participation in Medicaid. When fewer doctors participate in Medicaid, fewer patients have access to care.

Hard choices for physicians

Dr. Evelyn Johnson, a Brunswick pediatrician, says losing the pay hike would be devastating for physician practices.

A large majority of her patients in Georgia’s coastal region are on Medicaid. Johnson, president of the Georgia chapter of the American Academy of Pediatrics, says if the pay reverts to the former rate, “I wouldn’t be able to take new Medicaid patients.”

“I’m trained to serve the underserved,’’ Johnson says. But she adds, “There are only so many patients I can see in a day. If kids can’t get into a doctor to be seen, they will wind up in urgent care or the emergency room,” which will run up higher costs for the state.

Many physicians don’t take Medicaid patients, or limit the number they will take, notes Johnson, a solo practitioner.

Extending the pay raise “is the right thing to do,’’ Johnson says. Children, who make up the majority of Georgia’s Medicaid beneficiaries, need the medical foundation that pediatricians provide, she adds.

For Dr. Michael Satchell, an Albany family physician, the pay raise “has been instrumental in accepting more Medicaid patients in my practice.”

It has allowed him to hire a nurse practitioner and a medical assistant. “Before that, what I was paid wasn’t covering my overhead,” Satchell says.

If the state doesn’t act to preserve the current rate, patients will find access to care more difficult, he says, with “fewer providers to choose from.”