Medicaid Physician Fees Remained Substantially Below Fees Paid By Medicare In 2019

Area of Science:

• Health Economics
• Public Health Policy
• Healthcare Access

Background:

• Medicaid enrollment has been growing, indicating increased demand for public health insurance.
• Physician reimbursement rates are a critical factor influencing healthcare provider participation in insurance plans.

Purpose of the Study:

• To analyze the trend of Medicaid physician fees relative to Medicare and private insurance.
• To assess the implications of low Medicaid physician fees on healthcare access for enrollees.
• To evaluate the impact of these fee disparities on potential Medicaid expansion initiatives.

Main Methods:

• Comparative analysis of physician fee data across different insurance types (Medicaid, Medicare, private).
• Examination of trends from prior years up to 2019.
• Assessment of the relationship between fee levels and healthcare access metrics.

Main Results:

• In 2019, Medicaid physician fees continued to lag substantially behind those of Medicare and private insurance.
• Despite increased Medicaid enrollment, the gap in physician reimbursement persisted.
• Low reimbursement rates present a barrier to care for individuals enrolled in Medicaid.

Conclusions:

• Persistent low Medicaid physician fees pose a significant challenge to ensuring adequate healthcare access for a growing beneficiary population.
• The findings underscore the need to address physician payment disparities when designing or expanding public health insurance programs, such as a Medicaid buy-in or public option.