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Medicaid, Medicare reimbursement rates for doctors in Md. to be equalized

Medicaid, Medicare reimbursement rates for doctors in Md. to be equalized

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‘This is a big win for physicians, but, even more, I think it’s a big win for Medicaid patients,’ says MedChi CEO Gene Ransom. (Submitted Photo)

In a move that doctors say will expand health care access for low-income Marylanders, physicians will begin to receive the same payment rates for treating Medicaid patients as they do Medicare patients, starting in July.

The increased Medicaid reimbursement rates, which were included in Gov. Larry Hogan’s supplemental budget for fiscal year 2023, has been a long-term priority for MedChi, or the Maryland State Medical Society, an organization that represents the interests of the state’s physicians. Gene Ransom, the group’s CEO, said the change will allow more practitioners to afford to take on Medicaid recipients as patients, increasing access to care for those recipients.

“This is a big win for physicians, but, even more, I think it’s a big win for Medicaid patients,” Ransom said.

Medicaid and Medicare payment rates will only be equal for services billed as evaluation and management, an umbrella that includes most office-based services, such as a checkup with a primary care doctor. Reimbursement rates for procedures can vary wildly, Ransom said, with Medicaid generally lagging Medicare.

In Maryland, Medicaid payment rates were raised to parity with Medicare rates in 2012, when the Affordable Care Act significantly increased the number of people covered by Medicaid, a move that MedChi says led a large number of physicians to begin accepting the insurance. The state again decreased its Medicaid payment rates once again in 2015, under the leadership of Gov. Larry Hogan, to only 92% of Medicare’s rates. Hogan brought that number up slightly, to 94%, the subsequent year, where it has stayed since.

The cut, among other budget cuts, was made as a way to improve the state’s financial health and set the stage for future tax cuts, Hogan said at the time.

Nationwide, Medicaid pays doctors at lower rates than Medicare — Medicaid reimbursement rates are only about 72% of Medicare rates, a 2021 study showed. On top of that, another study from the same year also showed that doctors encounter more problems billing Medicaid than they did billing Medicare or private insurers.

Ransom said he feels Medicaid recipients deserved the same access to care as Medicare recipients, something he hopes the state budget’s return to parity will lead to.

“If you think about it, you can have a very wealthy person living on a waterfront home getting full coverage from Medicare … but for Medicaid, you have someone who’s poor” who can’t access the same level of care, he said. Medicaid reimbursement rates being increased will “help a lot of Medicaid patients make sure they have a physician.”

Parity between Medicaid and Medicare payment rates wasn’t the only win for health insurance advocates this past legislative session. Legislation passed that will form a workgroup to study a potential subsidies program for small businesses that provide insurance to their employees, which could increase access to health care for many employees of small businesses statewide.

Another bill passed that will allow adults to access dental care through Medicaid, as did a bill called the Healthy Babies Equity Act allowing noncitizen pregnant women, and their babies, to receive coverage through Medicaid.


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