Funder: The Commonwealth Fund with additional support from the New York State Health Foundation

Author: David Bricklin-Small and Rebecca Thorsness, Center for Health Care Strategies

September 2012 | Technical Assistance Brief


On May 11, 2012, the Centers for Medicare & Medicaid Services (CMS) released proposed regulations on a provision of the Affordable Care Act (ACA) requiring Medicaid agencies to increase primary care reimbursement to parity with Medicare rates in 2013 and 2014. This rate increase can significantly impact the Medicaid primary care delivery system, potentially enhancing access for current and new beneficiaries and helping to reduce unnecessary emergency department visits.

Improving access to primary care is essential, particularly for states that are ramping up to serve the roughly 15 million Americans who will become eligible for Medicaid in 2014 through health reform. A primary aim of the rate increase is to promote primary care access for Medicaid beneficiaries, both existing and newly eligible. Through this provision, states will receive an estimated $11.8 billion, which is 100 percent funded by federal match in 2013 and 2014. Although federal funding for the increase is time-limited, PCPs, who often cite low reimbursement rates as a reason for not participating in Medicaid, may be more willing to accept Medicaid beneficiaries given these additional resources.

This brief outlines recommendations for leveraging the rate increase to improve primary care access. It provides practical guidance to help states:

  1. Engage PCPs around the rate increase;
  2. Target efforts to areas where Medicaid has struggled with primary care access;
  3. Address PCPs’ reluctance to participate in Medicaid beyond issues associated with reimbursement rates; and
  4. Measure the impact of the rate increase on primary care access.