ACP supports legislation that has been introduced in the U.S. House of Representatives that would require that Medicare payment rates serve as a floor for Medicaid payment rates  for primary care services. View joint letter of support for H.R.952  (the Kids Access to Primary Care Act). Despite the titles of the bills, the pay parity for primary care services would apply to all adult patients as well as children. We are urging AIMn members to engage with us, as part of a broad-based coalition effort, and urge their House members to cosponsor and pass this bill. 

Background: On average, a clinician treating a Medicaid enrollee is paid about two-thirds of what Medicare pays for the same services and only half of what is paid by private insurance plans. In addition, Medicaid enrollment has increased by more than 8 percent over the past year as a result of pandemic-related job and income loss, making the demand for primary care and pediatric clinicians in the Medicaid program more acute than ever. At the same time, physician practices have faced financial challenges due to decreased visit volume and increased expenses such as for staffing and technology to provide telehealth services. Physician practices that accept large numbers of Medicaid patients face further challenges.

Congress took action to raise Medicaid primary care payment rates to Medicare levels in 2013 and 2014, with the federal government paying 100 percent of the increase. Access improved as a result: for example, the policy change led office-based primary care pediatricians to increase their participation in the Medicaid program. Unfortunately, lawmakers failed to reauthorize the payment increase after 2014. H.R. 952 would bring Medicaid payments for primary care services back in line with Medicare payment levels. H.R. 952 would also include related primary care services provided by our IM subspecialists, not just primary care internal medicine.

Action Requested: Please email your U.S. Representatives and urge them to co-sponsor H.R. 952.