Funder: The Commonwealth Fund

Author: Tricia McGinnis, Julia Berenson, and Nikki Highsmith, Center for Health Care Strategies

January 2011 | Brief


As Medicaid completes its transformation from a welfare program to the nation’s largest health insurance purchaser, it must refocus efforts to build a strong and robust primary care system. Health care reform legislation passed in 2010 requires reimbursement for Medicaid primary care providers at parity with Medicare rates in 2013 and 2014. States can use this rate increase to expand the Medicaid provider network, encourage greater use of quality and access measurement, and build more advanced models of primary care.

To achieve these goals, the Centers for Medicare & Medicaid Services (CMS), state Medicaid programs, and other stakeholders must work through numerous policy and technical implementation issues. This brief highlights nine critical issues, and identifies efficient implementation approaches that can benefit the primary care delivery system well beyond 2014.