Funder: The Commonwealth Fund

March 2011 | Technical Assistance Tool


The Affordable Care Act’s (ACA) expansion of Medicaid eligibility to 16-20 million new beneficiaries beginning in 2014 could generate unsustainable pressure on Medicaid’s already taxed network of primary care providers (PCPs). To encourage broader PCP participation in Medicaid and ensure patient access to primary care, the legislation requires Medicaid agencies to increase PCP reimbursement to reach parity with Medicare rates in 2013 and 2014.

Implementing Medicaid Primary Care Rate Increase: A Roadmap for States was developed by CHCS to guide states through the planning and implementation process. The roadmap can help states: (1) understand critical parameters of the increase; (2) identify the operational steps to prepare for and implement the increase and apply for the federal match; and (3) identify potential levers to enhance primary care access and quality.

The roadmap is a product of Leveraging the Medicaid Primary Care Rate Increase, a CHCS initiative made possible through The Commonwealth Fund. CHCS is working with Medicaid stakeholders, including CMS, state Medicaid agencies, health plans, physician organizations, and health policy experts, to maximize the long-term impact of the primary care rate increase on health care quality and access.