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FL Medicaid pay for doctors could soar

Florida doctors who treat Medicaid patients are paid a pittance – less than it costs to cover their overhead. But they will have more incentive to treat the poor as of Jan. 1, assuming the Affordable Care Act is still in force.

A provision in the health law will raise pay rates for primary care under Medicaid to the same level as Medicare, the federal program for retirees and the disabled. The pay change would have more effect in Florida than almost anywhere else, since Medicaid rates are among the lowest and Medicare rates among the highest in the nation.

Most primary-care doctors who treat Medicaid patients in Florida would see their pay rate almost double, according to a Health Affairs study published in 2009. Urban Institute health economist Stephen Zuckerman, author of the study, said more recent data show that if anything, the Medicaid-to-Medicare ratios in Florida have fallen since then.

"There's no question that this policy change...will have a very substantial impact for primary care physicians who treat Medicaid patients in Florida," Zuckerman said in a phone interview.

The idea behind the raise in pay is to increase Medicaid patients' access to primary care and prevention, said officials from the U.S. Department of Health and Human Services, which released details on Wednesday. They said the difference in pay will be covered 100 percent by federal funds for two years.

Zuckerman said it's not yet clear whether primary-care doctors who don't take Medicaid today will be willing to start, given that the funding is assured for only two years. Some in Florida are also cautious about the long-run effects.

“It’s a positive step for primary care,” said Jay Millson, executive director for the Florida Academy of Family Physicians. “We think it’s wonderful; it would certainly improve access.”

But he’s afraid to count on it. “There are several potential scenarios that could derail this. It’s hard to be optimistic, politics being what they are these days.”

Assuming the proposed ruletakes effect as scheduled, those who would benefit most could well be children, who account for the majority of Medicaid patients.

The Florida chapter of the American Academy of Pediatrics is suing the Agency for Health Care Administration in federal court, arguing that Medicaid’s rate-setting process results in pay so low it violates federal law.

A decision in that lawsuit, which covers dentists as well as medical doctors, could come in August.

Dr. Louis St. Petery, executive vice president of the Academy of Pediatrics chapter in Florida, reviewed HHS' proposed rule on Wednesday afternoon and called it "terrific."

By his calculations, the pay for a typical office visit -- to diagnose an upper-respiratory infection, for example, to determine whether it's a virus that will play itself out or a serious infection that needs antibiotics or fluids  --  will jump from the current $32.56 to at least $65.

St. Petery, a pediatric cardiologist, was particularly pleased that HHS' proposed rule will cover pediatric sub-specialists, since they have responsibility for the sickest newborns. More than half of newborns in Florida are covered by Medicaid, he said.

The rule also sets realistic pay codes for treatments that Medicare doesn't cover, including many in pediatrics.

"It looks like they listened to us," he said.

Florida Medical Association's comment, sent via e-mail and attributed to VP of Government Affairs Rebecca O'Hara, was less enthusiastic: "The FMA has advocated for increased physician reimbursements for physicians serving Medicaid patients. We will continue to champion this issue until physicians are fairly compensated for their services. Unfortunately, Medicare and Medicaid payments to physicians rarely cover the cost of delivering care."

FMA is dominated by specialists, who are not affected by the proposed pay raise for primary care.

AHCA officials didn't comment directly, but sent some slides that the agency presented to the Social Services Estimating Conference in conference in January. One of the slides shows that after the 100-percent federal funding for primary care pay raises expires, Florida could face a huge additional expense.

In fiscal year 2014-15, the added cost to maintain the primary-care pay raise is estimated at $188 million; for 2015-16, $383 million.

The Affordable Care Act expands the eligibility definitions for Medicaid to include those up to 133 percent of the federal poverty level beginning Jan. 1, 2014. For a family of four, that would equal an income of $29,326. 

Recent estimates show that about one in four working-age adults in Florida is uninsured. Altogether about 4 million Floridians were uninsured as of the 2010 census, according to

While Medicare is a purely federal program, Medicaid is jointly operated and financed by the states and federal government. One of the reasons Florida officials claim the Affordable Care Act is unconstitutional is that the expansion of Medicaid -- while federally funded at the outset -- will become a state burden over time.

In leading a 26-state lawsuit against the law, Florida also argues that it is unconstitutional to force individuals to obtain health-care coverage (the "individual mandate"). 

A federal judge in Pensacola declared the law unconstitutional, but courts in other regions yielded split decisions. The U.S. Supreme Court heard oral arguments in March, and is expected to render a verdict in late June.

--Health News Florida is an independent online publication dedicated to journalism in the public interest. Contact Editor Carol Gentry at 727-410-3266 or by e-mail.

Carol Gentry, founder and special correspondent of Health News Florida, has four decades of experience covering health finance and policy, with an emphasis on consumer education and protection.