Medicaid: Less money, lower reimbursement rates?

Less money for Medicaid in 2016 would mean lower reimbursement rates for health care providers that see most of the state’s Medicaid patients, officials said.

And that would translate into fewer doctors serving low-income Alabamians and the privately insured.

In Morgan County, 159 practices accept Medicaid under the Patients First primary care program.

“You’ll have fewer,” State Health Officer Don Williamson, who has helped oversee Medicaid since 2012, said about the number of practices if budget cuts proposed earlier this year become reality. “I can’t tell you how many, but you’ll have fewer. Some of them will stop taking Medicaid patients, and some will move out of Morgan County. And they’re not just gone for the Medicaid patients; they’re gone for all of them.”

Under the lawmaker-approved 2016 General Fund budget vetoed by Gov. Robert Bentley earlier this month, Medicaid would have been cut 5 percent, about $35 million, to about $650 million. Because federal matches can be up to multiple dollars for every state dollar, and because of new expenses next year, the hole is much larger — about $370 million.

Medicaid serves mostly the disabled, elderly, children and pregnant women. Doctors don’t have to accept Medicaid patients, and at their current reimbursement rate, some said they’re just breaking even on those patients.

The potential cut to doctors is two-fold under the 5-percent budget cut.

First, primary care providers are going to lose their “bump.” Medicaid reimbursements historically are less than that of Medicare and private insurance. Under the federal Affordable Care Act, Medicaid reimbursements were bumped up to Medicare levels.

“That was for calendar years 2013 and 2014,” said Linda Lee, executive director of the Alabama Chapter of the American Academy of Pediatrics. “At the state level, Alabama was actually good enough to include that in the 2015 year.”

Go to top