Funder: The Commonwealth Fund

Author: David Marc Small and Tricia McGinnis, Center for Health Care Strategies

January 2012 | Brief


Through the Affordable Care Act, in 2013 and 2014, Medicaid is required to reimburse primary care providers at parity with Medicare rates — a “bump” that is funded 100 percent by the federal government. This increase in Medicaid provider rates offers a potentially powerful tool that states can use to enhance access to and quality of primary care. Increased reimbursement also presents states with critical opportunities to implement advanced provider payment models and to align access, quality, and payment standards across Medicaid, its multiple delivery systems, and other public (e.g., the new insurance exchanges) and private payers.

Measuring the impact of the increase will be critical to helping states and policymakers understand the effects of increased reimbursement on access, utilization, and quality, and to making a case for sustaining the increase beyond 2014. This brief, produced with support from The Commonwealth Fund, outlines how Medicaid agencies can use performance measurement to assess the impact of the rate increase. It details potential access, utilization, and quality measures that can augment existing state measurement activities and outlines core considerations for states in developing and incorporating new measures. The brief also provides a practical crosswalk of Medicaid-relevant performance metrics across multiple national programs.

This brief is part of Leveraging the Medicaid Primary Care Rate Increase, a CHCS initiative to help states use the change in Medicaid primary care rates to drive improvements in access, quality, and payment reform.