State to cut Medicaid payments to doctors

Saturday, February 15, 2003

JEFFERSON CITY, Mo. -- The state has told health-care providers that it will trim Medicaid reimbursements next month to save money -- a move some doctors say may force them to stop seeing Medicaid patients or to go out of business.

At issue is health care for Missourians who are covered by both the state-funded Medicaid program for the poor and the federally funded Medicare program for the elderly or disabled.

For those patients, Medicaid typically reimburses medical providers for expenses not fully covered by Medicare. Those reimbursements will end under the policy change taking effect March 1.

Pam Victor, deputy director of the state Division of Medical Services, said some doctors have reacted to the news by threatening to stop treating Medicaid patients.

"Some of them are saying ... they are going to have to reconsider whether they cover these folks that are dually eligible" for both Medicaid and Medicare, she said.

Saving $18.8 million

Victor said the medical care of about 92,000 Missourians would be affected by the change, which would save the state an estimated $18.8 million during the fiscal year that ends June 30 and $24 million annually in future years.

The affected providers include physicians, midwives, podiatrists, nurse practitioners, psychologists, public health clinics and mental health centers.

State Rep. Rob Schaaf, a family physician, said he had no doubt that some doctors will close their practices as a result.

"I know there are doctors who will retire early because of just this one thing," said Schaaf, R-St. Joseph.

Schaaf said he knew of at least two doctors in the St. Joseph area who only treat Medicaid patients because they get payments from both Medicaid and Medicare. Payments from Medicaid alone do not cover the costs of care, Schaaf said, but when payments from Medicare are added, then doctors can break even.

At one time, Schaaf said, Medicaid recipients accounted for 30 percent to 40 percent of his own patient roster. But then he quit taking new Medicaid patients years ago because the reimbursement rate was much lower than the costs to provide care.

Schaaf said that if doctors stopped seeing Medicaid patients, more people might seek care at hospital emergency rooms -- or go without medical care altogether.

The two programs both have limits on the reimbursements for various medical procedures, with Medicare covering the majority of the cost and Medicaid paying the rest of what a doctor normally gets.

Under the new policy, if the federal Medicare payment is greater than what the state Medicaid payment would be, the state will pay nothing.

Victor gave the example of a $100 procedure for which Medicare has set a maximum reimbursement of $80 and Medicaid a maximum $75.

Currently, the doctor would receive $80 from Medicare and the balance -- $20 -- from Medicaid. Under the new formula, Medicaid would pay nothing, because the federal Medicare payment exceeds the state's maximum share.

In effect, Victor said, the state tells the doctor, "Sorry, but we're not giving you any of that $20 because Medicare has already reimbursed you actually better than Medicaid would have reimbursed you."

When the state Medicaid program calls for a higher reimbursement than Medicare, the new rules will only allow Medicaid to cover the difference between the two programs -- not the doctor's full costs.

Tom Holloway of the Missouri State Medical Association said 80 percent of all physicians in Missouri submitted claims to Medicaid last year, but just 34 percent submitted more than 50 claims. The new rules are going to mean fewer doctors will see Medicaid patients, he said.

"It's going to get less and less," Holloway said. "They just can't do it."

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