Federal court rules Oklahoma Medicaid doctor pay too low

Poor reimbursement hurts patient access, according to the decision, which physicians hope will inspire changes in other states.

By Mike Norbut, AMNews staff. April 11, 2005.

In what Oklahoma physicians are calling a landmark victory, a federal court recently ruled that the state's Medicaid program did not ensure equal access to eligible children because of insufficient payments to doctors.

The decision last month by U.S. Chief District Judge Claire Eagan sets the stage for fundamental changes to the Oklahoma Medicaid system that should result in better reimbursement rates and more doctors accepting Medicaid patients, physicians said.

The medical community also hopes it could spur changes in other states.

"The AMA is grateful that the court has recognized the impact of haphazard state budget cuts on the vulnerable Medicaid population," said American Medical Association President John C. Nelson, MD, MPH. "The court ruling demonstrates that state lawmakers must be accountable to the beneficiaries of Medicaid who often desperately depend on its comprehensive protection. It's time for state legislators to take a hard look at the consequences of dwindling reimbursements paid for Medicaid care."

Carol Berkowitz, MD, president of the American Academy of Pediatrics, said she hoped the court ruling would send a message to state programs to "accept their responsibilities under federal mandates."

"If physicians are receiving a payment that meets the costs of the office, it would guarantee more physicians will participate and there will be more access," said Dr. Berkowitz, a pediatrician in Torrance, Calif.

The judge found the Oklahoma program to be in violation of federal law because Medicaid reimbursement rates were not high enough to generate a suitable participation rate among physicians and care was not being delivered to the state's eligible Medicaid recipients "with reasonable promptness."