NCAFP Asks DHHS to Set Medicaid Rates at Medicare Level When Moving to Managed Care

In response to a recently released concept paper entitled, Supporting Provider Transition to Medicaid Managed Care, both the NCAFP and the NC Pediatric Society have called on NC DHHS to set primary care rate floors for Medicaid managed care at Medicare rates. During 2013-14, the federal government assisted states in increasing Medicaid rates to be on par with Medicare. Since then numerous states have funded the enhanced rate at or near Medicare rates in an effort to increase access to care for Medicaid recipients, and it has worked! North Carolina, however, did not continue the rate increase once the federal government ended full funding, dropping NC Medicaid rates to about 75% of Medicare. The NCAFP has taken a strong stance to reinstate parity rates as part of Medicaid transformation as one way to offset the increased administrative burdens practices will face under managed care. The Academy continues to argue that — given the importance of preventive services and disease management provided in the medical home – primary care rates should be increased.

DHHS also included increased provider satisfaction as a key tenet for Medicaid transformation, and the NCAFP believes that enhanced payment for the medical home will be needed to meet this goal. The NC Medicaid program continues to work on other avenues to reduce administrative burden during this transition and has outlined a way to assist providers in the concept paper (link). The NCAFP recently provided comments on this plan that offered additional suggestions to support family physicians, particularly independent primary care.