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Study: As Medicaid payment increased, so did pediatrician participation :

January 19, 2018

Primary care pediatricians’ participation in Medicaid increased after payments increased, according to a new study.

As part of the Affordable Care Act, states increased Medicaid payments to Medicare levels for primary care services for 2013 and 2014. To determine the impact of those increases, AAP experts analyzed data on more than 10,000 office-based primary care pediatricians surveyed in 2011-’12 and 2015-’16.

Results showed significant gains in the number of Medicaid patients accepted by existing providers.

“If your objectives are to improve the health of children who are publicly insured, the clear message is to pay fairly for their care,” said Mark L. Hudak, M.D., FAAP, co-author of the study “Increased Medicaid Payment and Participation by Office-Based Primary Care Pediatricians” (Tang SS, et al. Pediatrics. Dec. 22, 2017,

Medicaid insures more than 37 million children. Before 2013, the program’s payments for pediatric primary care across the nation averaged just 65% of Medicare payments and 53% of private insurance, according to the study.

Payment disparity influences how many pediatricians limit the number of Medicaid patients they accept. Some patients have a difficult time finding a physician close to them, especially a subspecialist, and getting an appointment could take months, according to Dr. Hudak, chair of the AAP Committee on Child Health Financing.

“Just because a child is insured by Medicaid doesn’t mean that child receives needed care in a timely fashion because of these real access issues,” he said.

The study showed Medicaid participation increased nationally by five different indicators; the first four below were statistically significant:

  • 6 percentage point increase in the average percentage of Medicaid patients per provider panel (to 31.3%);
  • 5.9 percentage point increase in those accepting all new Medicaid patients (to 43.3%);
  • 5.7 percentage point increase in those accepting new Medicaid patients at least as often as new private patients (to 55.6%);
  • 3 percentage point increase in those accepting some new Medicaid patients (to 77.4%); and
  • 2.1 percentage point drop in nonparticipants (to 14.6%).

Looking more closely at 27 states, the team found just six witnessed an increase in the number of pediatricians participating in Medicaid, but there were gains by other participation measures. Sixteen states increased participation by at least one measure, 11 increased it by two or more measures and three states gained according to all five measures.

Authors noted the increases in participation came despite issues with implementation and payments, and the knowledge that payment increases were temporary. After the increases expired, each state determined whether to continue to use its own funds to maintain equitable payments.

Dr. Hudak encouraged continued advocacy for payment equity and said federal and state governments should consider the long-term implications of improving children’s health.

“Doctors can’t address every adverse social determinant, but they can help a child reach early adulthood in better physical and mental health and prepared with the proper tools to lead an informed and healthy lifestyle,” Dr. Hudak said. “If young adults actively avoid risk factors for adult diseases, that will carry a very large return on investment for this country 10, 20 and 30 years from now. And the extra investment needed is relatively quite small.”

In a related commentary (, Stephen Berman, M.D., FAAP, encouraged states to maintain payment equity between Medicaid and Medicare. To increase pediatrician participation, he suggested raising rates for preventive care and vaccine administration, offering incentives for meeting certain targets and simplifying claims filing. He also recommended Medicaid systems better integrate primary care with subspecialty and mental health care.

“Medicaid coverage has become the health insurance safety net for approximately half of America’s children,” Dr. Berman wrote. “… If these children are to receive needed care, state policy makers will need to ensure that Medicaid payments will lead to equal access that is consistent with the law.”

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