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'Devil is in the details' about Medicaid pay hike

By Catholic Online (NEWS CONSORTIUM)
October 24th, 2012
Catholic Online (www.catholic.org)

President Barack Obama's plan to recruit more doctors to treat the poor is a simple one: Through the new health-care plan, doctors would be paid more money to treat patients on Medicaid, for a period of two years. It's a good idea - but not a simple one. As they say, the devil is in the details .

LOS ANGELES, CA (Catholic Online) - Primary-care doctors, when treating patients on Medicaid beginning on New Year's Day of 2013, will get the same rates they are paid when caring for seniors in the Medicare program. The higher rates will last for two years.

Medicaid fees vary by state, intended to treat the poor and less fortunate, they are generally cost far below Medicare and private plans. According to an Urban Institute analysis, rates the change will cost $11 billion and will be paid for by the federal government, which translates into a 64 percent average pay increase.

Implementing the raise will not be that simple. "The higher rate sounds great and was used by the Obama administration to sell the law, but the devil is in the details and we don't yet have the details to go out and recruit doctors," J. Mario Molina, chief executive of Molina Healthcare says. Molina Healthcare is one of the nation's largest Medicaid managed-care health plans with 1.8 million members.

Doctors, state officials and Medicaid managed-care plans say there are numerous details still to be worked out, given the two months between now and 2013.

The Obama administration has not issued final rules for the pay hike and most industry officials don't expect one until after Election Day.

In addition -- some states have been hesitant to promote the provision because Republican presidential candidate Mitt Romney has vowed to repeal the health-care law if he is elected.

Among the many several details that have yet to be resolved:

-- It's not known which doctors can get the higher pay. Traditional primary-care doctors are assumed to be covered. But some specialists, such as pediatric cardiologists, also could be eligible if they provide a certain amount of primary care.

-- Medicaid managed-care plans, which today enroll about half of the 60 million Medicaid recipients, are unsure how the additional compensation will be passed on to them and how they will compensate doctors who are paid a flat or capitated monthly fee.

-- The federal government hasn't published its Medicare rates for 2013. Doctors don't know what the increases will be for Medicaid.

-- Doctors are worried that there is no deadline on when states have to reimburse them at the higher rates.

 "This has tremendous implications for increasing access to primary care, especially in states like Florida and California, where Medicaid rates are very low, but only if it can be implemented properly and relatively soon," Molina says.

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