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Delaware Health Law Blog

CMS Proposes Raising Medicaid Payments to Primary Care Physicians

In a proposed rule announced on Wednesday, CMS seeks to provide states more than $11 billion in new funds to improve Medicaid primary care from 2013 through 2014. The proposal, if finalized, would implement requirements of the Patient Protection and Affordable Care Act designed to help primary care physicians and networks prepare for the increased enrollment following implementation of healthcare reform. Assuming the Affordable Care Act is not declared unconstitutional by the Supreme Court this summer, CMS will likely finalize the rule later in the year. The Affordable Care Act requires that Medicaid reimburse certain primary care specialties, including family medicine, general internal medicine, and pediatric medicine, at the levels of Medicare reimbursement for calendar years 2013 and 2014. This increase in payment is entirely funded by the federal government and States will not need to provide matching payments. Currently, the national average Medicaid payment rate is only two-thirds of what Medicare pays. In Delaware, the payment rate is 54% and below, according to data published by American Medical News. Some physicians are expressing concern about what will happen after 2014 to practices that accept more patients during the pay increase. Once the payment rates return to current numbers after 2014, will primary care practices suffer the consequences of taking in a larger patient population with lower paying insurance? The rule can be read here. ( are due June 11th.

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