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Health care act allows boost to Medicaid pay for doctors

Some state doctors soon will receive more money for treating Medicaid patients, providing at least temporary relief from the program's low reimbursement rates.

Under a provision of President Barack Obama's Affordable Care Act, the federal government will give states extra money to boost Medicaid reimbursements to primary care physicians.

Through 2014, primary doctors will be paid just as much to treat Medicaid patients as they are for Medicare services, which are traditionally more lucrative.

Penney Hall, Medicaid spokeswoman for the state Department of Health and Human Resources, said that adds up to an additional $24 million for state doctors.

She said it's unclear how many state doctors would qualify, but there are about 2,100 primary care physicians in the state who treat Medicaid patients.

Doctors need only to file a form with DHHR to receive the extra money, showing they are eligible for the increased reimbursements. About 500 physicians have already submitted forms.

Hall said the first of the higher paychecks should be disbursed in early August. Eligible doctors also can claim retroactive payments back to Jan. 1 of this year.

Medicaid traditionally has paid doctors far less than Medicare.

In 2012, West Virginia's Medicaid program paid only 80 percent of Medicare fees, according to a 2012 Report from the Kaiser Family Foundation.

For primary care services, Medicaid paid only 74 cents for every dollar spent by Medicare, the report found.

Both government health insurance programs still pay far less than private health insurance, however.

Only certain physicians and services will be eligible for the increased reimbursements.

"It's more for evaluation and management of the patient," Hall said.

Primary care physicians, as well as nurse practitioners and physicians assistants that work in their practices, will be eligible for the pay increase. The reimbursements will apply only for office visits and vaccinations, not for medical procedures like surgeries.

Brandon Merritt, a health care analyst at the West Virginia Center on Budget and Policy, said the increased reimbursements are meant to encourage doctors to treat Medicaid patients when West Virginia expands the program on Jan. 1, 2014.

About 91,500 additional state residents are expected to join Medicaid.

"The idea is to get more providers," Merritt said. "They're worried about the overloading of the system."

Unlike hospital emergency rooms, there is no law requiring private physicians to treat uninsured or government-insured patients. And there is currently little financial incentive for doctors to treat Medicaid patients.

Evan Jenkins, executive director of the West Virginia State Medical Association, told the Daily Mail earlier this year that most doctors have to limit the number of Medicaid patients in their practice.

"I'm not aware of any medical practice that could survive financially . . . solely on a Medicaid patient population," he said.

This increase in reimbursements would likely soothe that financial sting. It won't have much impact on state hospitals, however.

Joseph Letnaunchyn, president of the West Virginia Hospital Association, said the increased payments would benefit hospitals only if they own a primary care practice.

"But that will likely just cover the cost of running the practice," he said.

It's also unclear if the reimbursements will last past 2014. Hall said after next year, it will be up to states to decide whether or not the higher Medicaid payments will continue.

"We'll have to see where we are, budgetary-wise," she said.

Doctors could have received the higher reimbursements earlier this year, but Hall said the state had to have its plan for the payments approved by the federal Centers for Medicare and Medicaid Services.

DHHR received federal approval only a few weeks ago. The agency also had to update its computer systems to allow doctors to receive the higher payments.

Contact writer Zack Harold at 304-348-7939 or Follow him at


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