Advocacy Update: Medicaid Rate

Access to quality, timely health care is essential for children to grow up healthy and reach their full potential but due in part to the low rates paid by Medicaid, there are communities in our state where people covered by Apple Health for Kids can’t access pediatric health care.

That’s why WCAAP advocated for the state to continue the Affordable Care Act’s increase of Medicaid rates to parity with Medicare when the federal increase expired in 2015, and why we continue to advocate for the state to raise the Medicaid rate to Medicare levels across the board. It has been a long process, but thanks to WCAAP members’ tireless advocacy we have made great strides in educating legislators about the issue. In the 2018 legislative session, the legislature directed the Health Care Authority to increase Medicaid rates for pediatric primary and specialty care for one year through a $13.8 million budget appropriation. Included E&M codes will be increased by 9.5% and vaccine administration will be increased to 77% of Medicare rates.

While this increase is not adequate, it is a step in the right direction. The increase is effective from October 1, 2018 through June 2019. Here you will find detailed information about increases for pediatric primary and specialty care: Enhanced Pediatric Rates. It is critically important that providers work with Medicaid Managed Care Organizations to assure this increase is put into effect October 1. In addition to proactively working with Managed Care Organizations, providers should monitor reimbursement to be sure you receive the enhanced rates. No attestation is necessary for this rate increase. WCAAP will convene a webinar later in October to help assure you have the information you need.

WCAAP will continue to fight to bring Medicaid rates to full parity with Medicare. You can help! Patient stories are the heart of our advocacy and crucial to our success. If you know of families who have had trouble accessing care and are willing to share their stories, please let Jennifer Donahue know. You can reach her at or 206-713-1087.