Washington should close the primary care funding gap

Thousands more Pierce County low-income families now have the security of health care coverage with the recent Medicaid expansion. But with more than 19,760 new adult Medicaid enrollees in the county so far, some families may find themselves facing another hurdle in getting the routine care they need – accessing a physician accepting new Medicaid patients.

Regardless of what insurance you have, you want to know that you can see a physician when you need one and that routine care like checkups and immunizations are simple to access. But the number of physicians serving Medicaid patients may not keep pace with growth.

The Legislature can address this issue now by extending an increase in Medicaid reimbursement rates that the federal government recently funded.

Medicaid currently serves more than 1 million low-income residents in Washington, including 42 percent of Washington’s children, more than 472,000 of them. In Pierce County, more than 60,000 people rely on Medicaid to access health care; that number is growing as more people enroll.

But a clinic or physician aiming to take on more Medicaid patients faces economic uncertainty stemming from a possible six-month funding gap in Medicaid reimbursement rates that would drop their reimbursement down to well below the cost to provide that care.

Before 2013, a typical adult routine follow-up visit insured under Medicaid might cost a provider $85 to provide, but was reimbursed at $39, a clear loss to the provider. Thousands of new Medicaid enrollees combined with low Medicaid rates could add up to hundreds of thousands of dollars that primary care practices would need to absorb to provide care.

In anticipation of Medicaid expansion in 2013, policymakers and physicians across the country agreed it was time to address increasing access to preventive and primary care by approving federal funding for a Medicaid rate increase for primary care through 2014.

This federal funding made it possible for physicians to accept more patients on Medicaid and still keep their clinics economically stable.

However, federal funding ends after December 2014, and the state budget doesn’t start until July 2015, which leaves a six-month funding gap through June 2015. To cover the gap, Washington needs a $24.8 million adjustment in the supplemental budget.

If this gap is not filled, many primary care physicians may not have the economic stability they need to accept new or more Medicaid patients.

Fewer available physicians will create access challenges for insured citizens. That will surely result in patients showing up in the emergency room, at much greater expense to the state. It will also result in loss of continuity of care for chronic conditions such as asthma or diabetes.

At a time when primary care physicians will be in high demand, a gap like this is irresponsible. To provide appropriate, long-term care, primary care physicians need a long-term commitment to fair Medicaid compensation from the state and covering the six-month gap is the first step.

Dr. Nick Rajacich, an orthopedic surgeon practicing in Tacoma, is past president of the Washington State Medical Association.