Opinion: Raise Medicaid Reimbursement Rates

Charlie’s mom waited in his pediatrician’s office for hours, hoping for a walk-in appointment. Charlie, a 2-year-old, had a stomachache and his mom was worried.

The office had no available appointments for several days, and fewer of the nearby clinics accepted Medicaid. Even though his pain was not worsening, his mom knew they couldn’t wait several days. Not knowing where to turn, she brought Charlie to the emergency department.

Imagine a world where kids on Medicaid with symptoms like Charlie’s could find care at their local pediatrician’s office, instead of landing in the emergency department where an evaluation costs four times as much and the physicians are strangers. Taxpayers would save money by preventing illness, decreasing unnecessary emergency-room visits and reducing hospital admissions.

How might we make this vision a reality? The answer lies in providing all children, rich or poor, equal access to medical care by raising Medicaid reimbursement rates.

Currently, children on Medicaid face big disadvantages when accessing medical care compared to their privately insured peers because Medicaid reimbursement rates are too low. These kids have fewer options of available clinics and longer wait times for appointments. The community health clinics that do accept Medicaid are overwhelmed with patients.

Half of the children in Washington state are insured by Medicaid. Medicaid pays only 65 percent of the reimbursement rate of a typical commercial insurance plan or Medicare, which often does not even cover the cost of treatment. That’s right — clinics that see children with Medicaid lose money when they evaluate and treat these kids.

The federal government recognized this issue and increased Medicaid reimbursement rates to match Medicare rates from 2013 to 2014, dramatically increasing the number of practices that could afford to treat children with Medicaid. At the time, 75 percent of small primary-care pediatric practices surveyed in Washington indicated that they would stop accepting, reduce or limit the number of new Medicaid patients in their practices if the federal increase were discontinued.

Unfortunately, that’s exactly what happened. The rate increase expired Dec. 31, 2014, and we are starting to feel the consequences.

For example, the Everett Clinic, a large multidisciplinary medical clinic in Snohomish County, was recently forced to close its doors to new patients with Medicaid. Estimating $5.7 million lost per year treating Medicaid patients, the clinic simply could not absorb more losses.

Under the current reimbursement system, we fall short in serving one in two children in Washington state like Charlie who are insured by Medicaid. These are the kids who need our help the most. Chronic adult health concerns, such as heart disease and diabetes, are often rooted in childhood. Kids with limited access to health care grow up to be unhealthy adults with costly medical bills. The impact is dramatic and expensive.

We must invest our health-care dollars in children by investing in Medicaid. The Washington state Legislature can help this year by raising the Medicaid reimbursement rate for kids to match that of Medicare, an average investment of just $9 per child on Medicaid.

We must implement reimbursement policies that value the health of underserved children to allow all children access to the health care they deserve.

Dr. Andrea Posa is a pediatrician living in Seattle and is a member of the Washington Chapter of the American Academy of Pediatrics. Dr. Michael Dudas, chief of pediatrics at Virginia Mason, is president of the Washington chapter of the American Academy of Pediatrics.