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Reforming Medicaid

A federal-state program which provides health coverage to low-income Americans, Medicaid programs across the country are in a period of fundamental and rapid change which will have a long-lasting impact on Medicaid patients and the physicians who care for them. In June 2012 the Supreme Court of the United States issued its landmark decision in National Federation of Independent Business v. Sebelius which in effect leaves Medicaid expansion as provided in the Affordable Care Act (ACA) optional for the states. The Court left all other Medicaid provisions in the ACA intact, including changes to the way states calculate income to determine eligibility, implementation of Medicaid recovery audit contractors, and increased payment for primary care providers. In addition to ACA implementation, many states are implementing broader delivery system and payment reforms within their Medicaid program. These reforms will make significant changes to the way care is provided by physicians and other health care providers to Medicaid patients.

Your AMA has devoted signification resources to creating a campaign focused on preserving Medicaid budgets. Below is a sampling of the state advocacy tools that exist related to this campaign. Please contact Annalia Michelman, JD, Senior Legislative Attorney, with any questions.

Medicaid Expansion
Medicaid Delivery and Payment Reform
Medicaid Recovery Audit Contractors (RACs)

Campaign resources

Issue brief:
Medicaid RAC

Medicaid recovery audit contractors summary:
RAC final rule  

Chart:
Medicaid RAC program contacts by state 

Talking points:
State advocacy roadmap Medicaid RAC

Physician Reimbursement and Access to Care

Campaign resources

Summary of research:
Medicaid physician reimbursement

Talking points:
Medicaid cuts to physician payment 

Primary Care Payment Increase
Preventing Mandatory Participation Requirements
Dual Eligibles

Dual eligibles are individuals who receive both Medicare and Medicaid coverage. There are currently approximately 9 million dual eligibles across the country.

Dual Eligibles