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Cutting Our Future: Medicaid Provider Rates

Medicaid is an important lifeline for kids whose families would otherwise be unable to afford health insurance.  Having health insurance, especially when kids are young, is a critical component of ensuring healthy development.  In 2010, 69% of all Medicaid participants in Nebraska were kids.

But having health insurance alone isn’t enough to ensure that kids are getting the care they need.  They also need to be able to get in to see a doctor.

It seems that just about every time there are budget challenges in Nebraska, there is also a proposal to cut what we pay doctors who treat Medicaid patients — known as provider rates.   The recent budget request from the Department of Health and Human Services proposes cutting Medicaid provider rates by 3%.

What we pay providers matters because it plays a significant role in the decision that health care providers make to accept Medicaid as a form of insurance.  If we make provider payments too low, it can result in too few providers accepting Medicaid.  Kids insured by Medicaid then aren’t able to get in to see a doctor when they need one.  In fact, one recent study found that about a third of all doctors nationwide won’t accept new patients if they are insured through Medicaid.

Lack of access to providers can also create problems with how our health care system is functioning.  Those that can’t get in to see a doctor are more likely to end up in the emergency room, which is a more costly and less efficient form of care.

In order to ensure meaningful access to care for kids on Medicaid, we need to pay providers a fair rate.   We need to ensure that the changes we make to our health care system are forward looking and support things that we know work — like getting kids to the doctor to prevent issues instead of driving more providers out of the system and more families toward the use of emergency care.

 

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Comments(2)

  1. REPLY
    Louise says

    It is already a reality for mental health providers that many can not accept Medicaid eligible clients. Medicaid has succeeded in insuring that their demands are too cumbersome for providers, especially solo practitioners. You can look at the Adverse Childhood Experiences study, as well as Nebraska child abuse/neglect fatality rates, which nearly doubled between 2001 and 2008, the majority of which were children under the age of 4 – the very population that Medicaid has refused to authorize services for. It is a no brainer that this approach is absolutely folly and counterproductive to a healthy, well-functioning force for our future. Nebraska’s version of the Hunger Games lottery, I suppose. No one can label this a budget or fiscal issue. The research is VERY clear that early intervention is extremely cost effective. In our state it is a matter of priorities. So very sad!

    • REPLY
      Aubrey Mancuso says

      Thanks for you comment, Louise. We agree that it’s a matter of priorities and will continue to make that argument as the budget debate gets underway.

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