Medicaid Professional Services Rate Increase
As articulated in its
2023-2025 strategic plan, the WSMA is committed to focusing on the biggest funding challenge
faced by physicians and health care providers: Medicaid payment rates that
do not come close to covering the cost of care and do not support access
to care for the most vulnerable. During the 2023 legislative session, the
top priority for the WSMA will be to seek the Legislature's support for an
increase in Medicaid reimbursement rates for professional services.
2023 Issue Brief: Medicaid Professional Services Rate Increase
Our ask of the Legislature in 2023
During the 2023 legislative session, the WSMA will ask the Washington
State Legislature to improve access to care for Washingtonians enrolled in
Medicaid by supporting an increase in Medicaid reimbursement rates for
professional services delivered by physicians, physician assistants, and ARNPs to the equivalent paid by Medicare, adjusting to
inflation moving forward. The estimated fiscal impact for the 2023-25
biennium is $200.4 million in state general funds, leveraging a more than
2-to-1 federal match for an overall investment of $634.8 million.
Studies show that raising Medicaid reimbursement rates is the
most effective method of increasing physician and health care provider
participation in Medicaid networks. Prioritizing a broad-based Medicaid reimbursement rate increase will
improve access to care for Washingtonians by expanding physician
participation in Medicaid networks at a time when it is desperately needed
and long overdue.
Without access to quality health care services, preventable emergency room
visits increase as Washingtonians are forced to seek out episodic care,
and health outcomes worsen. These patterns exacerbate health disparities,
which have already been magnified by the pandemic.
Background on the Medicaid program in Washington state
The Affordable Care Act's Medicaid expansion and state-level program
changes have dramatically increased Medicaid eligibility, but it has been
at least a dozen years since there has been a broad-based Medicaid
reimbursement rate increase. The rate increases funded by the Washington State Legislature in 2021
for primary care, behavioral health, and pediatric services were
much-needed first step; however, all specialties are impacted by low
Medicaid reimbursements-patients with cancer, joint replacement needs, and
other specialty services also deserve timely access to high-quality care.
Our state receives the
lowest federal contribution for Medicaid rates (FMAP)
and only two states reimburse specialty services
at lower rates. When the state allocates funds toward Medicaid reimbursement, the
federal government contributes significant matching funds, stretching the
impact of state investments. While the WSMA is thankful for the
Legislature's recent targeted investments, Medicaid rates need to be
increased across the board for all specialty services to truly improve
access to care.
Physician practices, medical groups, and hospitals, like the rest of the
economy, are struggling with high inflation. They are also under enormous
pressure to bring patients up to date on care that was delayed and
worsened during the pandemic with a workforce that has been depleted. But
while other sectors of the economy may adjust prices to balance their budgets, physicians providing care for patients on
Medicaid are at the mercy of the Legislature and the state budget.
The impact of low Medicaid reimbursement
Physicians want to be able to care for all patients, including
those on Medicaid. But financial pressures limit their ability to do so
and financial viability is strained when they do. When Medicaid
reimbursement doesn't cover the cost of delivering care, physicians must
limit the number of Medicaid patients they serve or risk jeopardizing
their ability to keep their practice doors open.
Medicaid added 400,000 enrollees during the pandemic and now covers over
2.2 million residents in our state,
nearly 30% of Washingtonians. Many people delayed medical care throughout the pandemic, resulting in
patients presenting in clinics and health care facilities with more acute
conditions. It's more important than ever that all residents of our state
have access to specialty medical care.
Medicaid disproportionately serves families of color, low-income
communities, and children, meaning that these patients
disproportionately face difficulty accessing timely, cost-effective
care. Medicaid is one of the primary avenues of health coverage for residents
of our state. It's imperative that the state help ensure access to care
for all residents by adjusting reimbursement rates to more accurately
reflect the cost of delivering care.
More information
Contact WSMA Director of Government Affairs Sean Graham at
sean@wsma.org or 360.259.4184.