Medicaid Primary Care Pay Parity

Congress should help improve access to primary care for patients enrolled in Medicaid by restoring Medicaid Primary Care Pay Parity. Senators should co-sponsor the Ensuring Access to Primary Care for Women & Children Act (S. 737), and House members co-sponsor the companion legislation (H.R. 2253), and then expedite action by both chambers to pass the legislation. This bill ensures Medicaid payments for primary care and immunization services are reimbursed at no less than what Medicare pays for the same services. 

What’s it all about? Medicaid, the health insurance program for low-income individuals, is funded jointly by the federal government and individual states. Medicaid covers 70 million people and continues to grow; in fact, it is the largest single source of coverage in the country.

Unfortunately, having Medicaid coverage does not guarantee access to a physician and many low-income, vulnerable patients have difficulty finding a doctor. Historically, Medicaid has paid well below private insurance plans and Medicare, particularly for primary care services. In 2012, the average Medicaid primary care payment was 59 percent of Medicare’s fee. Low reimbursement is one of the top reasons physicians cite for not participating in Medicaid and many physicians are financially unable to serve Medicaid patients.