AAFP SpeakOut

Please utilize the AAFP Speak Out system to indicate your support for the federal extension of the primary care rate increase.

The American Academy of Family Physicians has been lobbying at the federal level to extend the Medicaid Primary Care Parity program past its expiration date of Wednesday, December 31. The program, active for the 2013 and 2014 calendar years, increased Medicaid payments for specified primary care services to Medicare levels for certain primary care physicians. If this program is not extended past this year, family physicians will see drastic cuts to their Medicaid payments, forcing many to limit or stop seeing Medicaid patients altogether.

What Is the Medicaid Primary Care Parity Program?

Congress enacted the Medicaid Primary Care payment program in 2013 to increase the number of primary care physicians that see Medicaid patients. The program increases Medicaid payment levels for certain primary care services performed by primary care physicians, along with a select few subspecialists with internal medicine and pediatric subspecialties. Increased payment for primary care services has improved access to these services for many Medicaid patients.

What Is the Status of the Program Now?

Unless Congress votes during the lame duck session this fall to extend the program, it will expire on December 31, 2014. Fortunately, by enacting the Ensuring Access to Primary Care for Women & Children Act (S. 2694), Congress can ensure that the program continues for patients enrolled in Medicaid, in West Virginia, and in every state across the country.

Why Is Primary Care Payment Necessary?

Medicaid covers more than 65 million Americans, and that number continues to grow as more people sign up for health insurance. From September 2013 to April 2014, West Virginia’s Medicaid enrollment increased by 43.4 percent. As the number of Medicaid enrollees increases, it is vital that policymakers make sure that our most vulnerable patients – over 500,000 in West Virginia enrolled in Medicaid – can access the health care they need from primary care physicians.

Research has shown that having health insurance does not guarantee access to timely, appropriate healthcare. This is particularly true of the Medicaid program, which has struggled to attract participating physicians because of low reimbursement rates. As a result, low-income children, the elderly, women, and other qualifying adults are having difficulties finding in-network primary care physicians. Prior to the implementation of the Medicaid primary care payment program, the payment for primary care services in West Virginia was 80% of Medicare rates. Of AAFP’s membership, 85% reported that they have the capacity  to accept newly insured patients, while just under two thirds (63%) currently accept Medicaid patients. Of these, over there quarters (77%) have the capacity to accept new Medicaid patients. Further growth in the number of Medicaid beneficiaries as patients enroll through the health insurance marketplace’s open enrollment process will further emphasize the need for primary care physicians. The bottom line is that this program protects, and increases access to primary care services by ensuring that physicians receive payments at least equal to Medicare rates for providing these essential services to Medicaid patients.


What Happens to Access If These Cuts to Medicaid Payments for Primary Care Go into Effect?

If Congress does not extend this vital program during the lame duck session, patients will face steeper barriers in accessing primary care, and physician participation in the Medicaid program will be undermined. An AAFP SpeakOut email sent at the beginning of Summer 2014 asked members how they would respond if the Medicaid primary care payment was not renewed. Most members replied that they would be forced to stop seeing new Medicaid patients, and likely have to limit, or cut the number of current Medicaid patients they already see. If these Medicaid payments for primary care are reduced to 2012 levels, West Virginia’s primary care physicians will face a pay cut of 20 percent for providing important primary care services.


Why Do We Need to Encourage Primary Care Physicians to Participate in Medicaid?

Many of studies show that patient access to primary care is correlated to lower cost of care and better patient health outcomes.[2] Therefore, if the Medicaid primary care payments are cut on December 31, 2014, health care costs in West Virginia will likely rise, and patient health outcomes will likely worsen. Data shows that patients dropped from primary care physician panels, or shut out of primary care offices will seek care in the emergency departments, leading to the higher costs and poorer outcomes traditionally associated with lack of access.



The American Academy of Family Physicians strongly opposes these pending cuts to Medicaid payments for primary care. If Congress does not act by the end of this year, physicians will face major reimbursement cuts (in some states, cuts will be over 20 times that of Medicare’s SGR cuts) that will force them to reconsider maintaining Medicaid beneficiaries on their patient rolls. These Medicaid payment rates for primary care are will help ensure that the sickest, and neediest populations in the country have access to the primary care physician who can provide efficient and high-quality health care.

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