Medicaid Reimbursement Is Not Keeping Pace With Medicare
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Barry University *
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312
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Medicine
Date
Apr 3, 2024
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docx
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Medicaid Reimbursement Is Not Keeping Pace With Medicare
HSA-610-01-2401: FIN/DEL OF HLTH CARE SER
Medicaid Reimbursement Is Not Keeping Pace With Medicare
Karla Vides
Barry University
02/18/2024
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Medicaid Reimbursement Is Not Keeping Pace With Medicare
Medicaid Reimbursement Is Not Keeping Pace With Medicare
Medicare reimbursement has provided consistent rates nationally but with different geographical areas, determined from one of three factors: percentage of Medicare, marketing assessment structured by the state, and relative value scale. They are lowering Medicaid reimbursement rates, equaling about 78% of Medicare reimbursement, with changes from state to state. Due to lower reimbursement rates in 2017, fewer and fewer medical providers have been
accepting lower percentages of new Medicaid patients. Following the example of new patient acceptance, 96% of new privately insured patients, 88% of new Medicare patients, and only 74%
of new Medicaid patients under specifications. Due to the low participation of providers in Medicaid, it will become challenging to equal access to care, diminishing the limited access to care for low-income patients in the United States they are currently facing. With the importance of reimbursement, the imaging department has been working with Medicaid and Medicare for the past ten years, with rates varying from state level, creating maps for each state. Analysis has verified the situation regarding Medicaid reimbursement rates for professional fees, including the rates in Alaska, California, New Mexico, Arkansas, Louisiana, Kentucky, West Virginia, New York, Vermont, and Washington, D.C. For example, in Rhode Island, only 32% of the population uses Medicaid, and 64% uses Medicare, but in Wyoming, 194% has Medicare, and only 12% uses Medicaid.
The Medicaid-to-Medicare reimbursement gap has increased over the past 10 years; in Rhode Island, a single-view chest X-ray rate has become one-third higher from 2012 to 2022. In other states, New York, Connecticut, and Rhode Island, for a more complex procedure, they have
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Medicaid Reimbursement Is Not Keeping Pace With Medicare
been paid half in 2022 than what was paid in 2024. Since the Medicare and Medicaid reimbursement gap has not been able to improve their insurance, the Affordable Care Act has been created, and Medicaid turned to the state-run program to view what will determine coverage. During the COVID pandemic, many people were laid off, which caused them to lose private coverage, forcing them to apply for Medicaid and increasing the enrolment rate.
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Medicaid Reimbursement Is Not Keeping Pace With Medicare
Reference:
Medicaid reimbursement is not keeping pace with Medicare. Medicaid Reimbursement Is Not Keeping Pace With Medicare | American College of Radiology. (n.d.). https://www.acr.org/Practice-Management-Quality-Informatics/ACR-Bulletin/Articles/June-
2023/Medicaid-Reimbursement-Is-Not-Keeping-Pace-With-Medicare