By Jonel Aleccia McClatchy News Service
OLYMPIA — More than 480,000 people in the state gained insurance in 2014 under the expanded Apple Health Medicaid program, but sizable cuts in payments to some doctors took effect Thursday, potentially making it harder for patients to find care.
Consumer advocates and University of Washington researchers said doctors are likely to restrict access for the state’s 1.7 million Medicaid patients — including the new enrollees — after a two-year bump in reimbursement rates ended Jan. 1.
The increase was a temporary benefit provided by the Affordable Care Act in 2013 and 2014.
“It does sound likely that certain segments of the state and physicians in certain types of practices say they’re either going to stop taking new patients or reduce their current panel,” said Davis Patterson of the Washington, Wyoming, Alaska, Montana, Idaho Center for Health Workforce Studies, who led new research on the local impact of the Medicaid fees.
Washington doctors could see their reimbursement rates for primary care drop by 36 percent next year, according to a new study by the Urban Institute.
That’s less than the 43 percent average cut nationwide or the 50 percent estimated reduction in some states, such as California, Florida or New York, according to an analysis by Stephen Zuckerman, a health economist at the Urban Institute.
But it amounts to a 28 percent cut in fees for primary care for children — and a 70 percent drop in reimbursement rates for doctors who care for adults under Medicaid, said MaryAnne Lindeblad, the state Medicaid director with the Washington Health Care Authority.
“Certainly, it could have an impact,” Lindeblad said.
For the past two years, state Medicaid agencies have been required to pay at least as much as Medicare pays for primary-care services.
President Barack Obama proposed a one-year extension of the higher payments in his March budget, but the odds of it progressing appear slim in a newly Republican-controlled Congress.
About 9.7 million people have been added to Medicaid nationwide since 2013, for a total of 68.5 million, federal figures show.
The Center for Health Workforce Studies’ fall survey talked with officials at the 13 largest health care organizations in the state as well as about 230 primary-care doctors in smaller practices in 15 counties.
Nearly three-quarters of doctors in smaller practices reported that they would restrict access for Medicaid patients if the reimbursements were cut, the study found. More than a third said they’d stop taking new patients entirely, while a third said they’d limit acceptance of new patients.
Overall, about one in five primary-care doctors said they’d cut back or stop seeing current Medicaid patients, the study found.
“We have historically had an open door to any and all patients on Medicaid,” one doctor wrote to researchers.
“With unavoidable overhead increase, this will have to stop if enhanced payments do not continue. Without them, I would have no income some months. Some months, the enhanced payment check is my only income.”
Still, most of the large health care organizations in the state said that the Medicaid payment increase — and its expiration — had no effect on their acceptance of Medicaid patients or on whether they’d continue care.
“No difference,” one administrator wrote.
“We are in a part of the state where if we do not do it, there is no one else.”
Most Medicaid providers realized that the two-year increase was only temporary and that the federal government was not likely to continue it, Lindeblad said.
More than 90 percent of people enrolled in Medicaid are in managed-care plans, which can offer or negotiate different payments for providers and might not be affected by the fee cuts, Lindeblad added.
Gov. Jay Inslee’s proposed state budget includes funding to replace the Medicaid cuts, but there’s no guarantee legislators will approve it, she added.
“We have many providers who limit the number of Medicaid patients who they accept already,” Lindeblad said.
“I would hope that providers would stay.”
Officials with the Washington State Hospital Association said they’re worried that the Medicaid fee cuts — in conjunction with other cuts, such as a proposed decrease in hospital-owned clinic fees — will threaten access to care for the most vulnerable patients.
They plan to ask legislators to address the issue this year.
“There are hundreds of thousands more people who now receive their health insurance through Medicaid and these cuts in combination could create a major crisis in access to care for new Medicaid enrollees,” said Cassie Sauer, the state hospital association’s senior vice president of advocacy and government affairs.
“We need to be sure that people don’t just have insurance but have providers that are able to care for them.”
