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GOVERNMENT

Medicare & Medicaid: A study in contrasts

Quick View. Oct. 15, 2007.

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Medicaid rates for physician services vary much more widely among states than do Medicare rates.


Highest Medicaid
to Medicare ratios
Medicare Medicaid Medicaid as percentage of Medicare
Alaska $97.41 $134.86 138%
Wyoming $85.61 $112.23 131%
Arizona $92.01 $96.91 105%
Delaware $93.08 $93.08 100%
North Carolina $87.49 $83.11 95.0%
Lowest Medicaid
to Medicare ratios
New Jersey $101.61 $25.00 25%
Pennsylvania $92.94 $25.00 27%
New York $101.69 $30.00 30%
Rhode Island $93.41 $29.00 31%
Washington, D.C. $104.78 $48.77 47%

As a result, per-service payments from the two programs come close to matching in some states, while in others doctors are paid much less for their low-income patients than for their elderly patients. The fear is that physicians in low-paying states will stop seeing Medicaid patients. Here is a sampling of what states pay for an initial office visit with a new patient under Medicare and Medicaid. The percentages reflect Medicaid payments in proportion to Medicare payments.

Note: rates for New Jersey, Pennsylvania and New York are average for state's multiple geographic Medicare payment areas

Source: "Equal Pay for Equal Work? Not for Medicaid Doctors," Public Citizen, September

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Copyright 2007 American Medical Association. All rights reserved.
 
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