Sens. Brown and Murray Introduce Legislation to Give Additional Health Providers the Ability to Treat Medicaid Patients

Legislation Will Help Guarantee Access to Primary Care for the Millions Covered by Medicaid. After Increasing Medicaid Payment Rates, More Providers Began Accepting New Medicaid Patients

WASHINGTON, D.C. – With more than 69 million Americans relying on Medicaid for their health care needs, U.S. Sens. Sherrod Brown (D-OH) and Patty Murray (D-WA) today introduced a bill to ensure access to primary care providers for Medicaid recipients.

The Ensuring Access to Primary Care for Women & Children Act would extend an expired provision of the Affordable Care Act (ACA) that would guarantee reimbursement parity between doctors treating Medicaid and Medicare patients. This would also apply to other medical professionals who treat women and children, including nurse practitioners and physician assistants. 

“Primary care providers represent a critical access point for women and families,” said Brown. “We should be making it easier for providers to accept new Medicaid patients, not harder. Expanding access to care is at the heart of the health law – and today millions more Americans have care through Medicaid. Now, we must align Medicaid reimbursements with Medicare rates to make sure these individuals can realize the promise of that coverage and get the quality care they need.”

“To make sure our health care system works for patients and families, we need to ensure that when a person get sick, they are able to get the care they need, when and where they need it.  Medicaid helps millions of families get quality, affordable health care coverage, and therefore plays a critical role as we work to meet this goal,” said Murray. “By aligning Medicaid reimbursements with Medicare rates, and expanding eligibility to the providers women are more likely to see on a regular basis, we can build on the progress made in the Affordable Care Act, continue expanding access to primary care, and help women and families across the country stay healthy and economically secure.”

The health law helped expand families’ access to health care services by aligning the payments that primary care physicians receive through Medicaid with Medicare’s higher payments. Because Medicaid provides coverage for millions of families, as well as access to critical health services for women, this ACA provision played an important role in meeting the increased demand for primary care. The Ensuring Access to Primacy Care for Women & Children Act would extend this provision – which expired at the end of last year – to again align Medicaid physician payments with Medicare payments for an additional two years.

In addition to increasing payments for Medicaid primary care physicians for two years, the Ensuring Access to Primary Care for Women & Children Act would also:

  • Expand eligibility for the payment increase for primary care services to OB/GYNs, nurse-midwives, nurse practitioners, and physician assistants. Women comprise the majority of Medicaid enrollees across all ages. In 2009, nearly three quarters of adult women enrolled in Medicaid were ages 18-44, of reproductive age. Six in ten women in this age group reported that they see an OB/GYN on a regular basis. Women are more likely to regularly see their OB/GYN than any other type of provider. In addition, nurse-midwives, nurse practitioners, and physician assistants are playing an increasingly important role in meeting growing demand for primary care. It is critical that this broader range of primary care providers receive reimbursement sufficient to participate in Medicaid.
  • Support more efficient use of program dollars. By aligning Medicaid payment rates with Medicare rates and expanding this alignment to a broader range of primary care settings, this bill would improve the efficiency of Medicaid dollars. This would help families avoid trips to the emergency room for treatment that is better suited for a primary care provider.
  • Improve quality and value for Medicaid beneficiaries. Recognizing the need for a sustainable model for future payment reform, the Ensuring Access to Primary Care for Women & Children Act will require the Government Accountability Office to publish a report examining the use of alternative payment models in state Medicaid programs. This legislation will also provide funding for the continued use of adult quality measures in Medicaid, and develop additional quality measures for individuals with disabilities.

Research has demonstrated that higher Medicaid payment rates significantly increase appointment availability for Medicaid enrollees. Studies have also shown that, because nurse practitioners and other mid-level health professionals, such as physician assistants, are trained to and already deliver many primary care services, extending the pay increase to these professionals could increase access to primary care, particularly in underserved areas.