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Reforming Medicaid

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The AMA believes that everyone deserves access to quality health care. To ensure low-income patients enrolled in Medicaid are able to receive needed care, the AMA works diligently at the state and federal levels to improve Medicaid programs, expand coverage options and make it easier for physicians to see Medicaid patients.

Access to Care

Research demonstrates that low Medicaid reimbursement rates significantly affect a physician’s ability to accept new Medicaid patients. Physicians have a strong sense of responsibility to provide care for Medicaid patients, but cannot remain economically viable if they lose money on the care they provide.  

Without enough participating physicians, patients may have coverage but not real access to care. Too often Medicaid patients face barriers to care, resulting in more frequent emergency department visits, delayed treatment of chronic conditions and poorer health outcomes.

To ensure Medicaid patients get the care they need, the AMA supports legislation that guarantees physicians be paid at least the Medicare rate. During 2013 and 2014, Congress increased Medicaid payments for certain primary care services in parity with Medicare payment rates. The AMA advocated for the continuation of federal funding of the enhanced payment rates, but Congress did not extend the increased payments. 

The AMA continues to work with state advocates to increase payments at the state level. The AMA is also working to improve physician participation rates in the program with efforts to streamline enrollment, ensure fair audit procedures and improve managed care programs.

Medicaid Expansion

The Affordable Care Act (ACA) gave states the opportunity to significantly expand their Medicaid programs. To date, 31 states and the District of Columbia have opted to expand coverage to all non-Medicare-eligible individuals with incomes up to 133% of the federal poverty level. Since this change, states have enrolled over 14.5 million new people into Medicaid, bringing total enrollment to nearly 72 million people nationwide.  

Several states are also testing new ways to serve the Medicaid population, including using the so-called “private option” to expand Medicaid eligibility under a Section 1115 Demonstration Waiver.

The AMA is working with advocates and policymakers at all levels of government to identify realistic coverage options for the uninsured and supports expansion plans that best meet the needs and priorities of states and low-income patients.

Download Resources

The AMA is working to facilitate strategies and communication among federation organizations dealing with these issues. The campaign has produced the following advocacy resources:

Access to Care and Physician Reimbursemen

Medicaid Payment and Delivery Reform

Physician Enrollment and Participation

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