Raise sought for Medicaid doctors

Governor will seek $25 million to boost fees for office visits

January 16, 2002|By M. William Salganik | M. William Salganik,SUN STAFF

Responding to a key recommendation of a health department evaluation of Maryland's Medicaid program, the governor yesterday proposed including an extra $25 million in the state budget to increase physician fees.

Matched by an equal amount of federal dollars, the new money will be targeted to physician office-visit reimbursements, said Debbie I. Chang, deputy health secretary, and will help assure the program attracts and retains enough participating doctors.

While the doctor fee increase is subject to the legislative budget process, Chang said other major recommendations of the evaluation - also released yesterday - can be accomplished by the health department without action by the General Assembly.

These include improving planning and monitoring, increasing the notice time for an HMO to leave the Medicaid program and reducing the paperwork burden on doctors.

Overall, the evaluation found that the program, called HealthChoice, has increased access to care, with many more Marylanders insured.

The evaluation also found HealthChoice enrollees receiving more preventive care than Medicaid members got before the program started, and making fewer emergency room visits - considered a sign that they are receiving good primary care.

When HealthChoice was launched in 1997, the state moved about 300,000 Medicaid enrollees - mostly welfare mothers and their children - into HMO-like organizations called managed care organizations, or MCOs.

The state pays the MCOs (there are currently six) a monthly fee per member based on his health.

Over the past few years, the state has liberalized income limits, allowing more children to qualify and pushing enrollment to 423,000 - more than 22 percent of the children in the state.

The evaluation released yesterday is the health department's first comprehensive review of the program.

Based on its overall positive findings, the department has reached agreement with federal officials to extend the program for three more years, Chang said. In addition to reviewing data, the department conducted 60 forums and focus groups with enrollees, doctors, advocates and others.

Some of those groups were less positive about the results from HealthChoice. "The data shows a marginal increase in [doctor] visits," said Bobbi Seabolt, director of public policy for the Maryland chapter of the American Academy of Pediatrics. "For the amount of time and effort, it's disappointing that the gains were that slim."

Carol Fanconi, health director for Advocates for Children and Youth, said the coverage of many more children is "terrific," but she believes the HMO model "doesn't work well for the poor because it erects barriers to care."

However, she said, "The biggest thing, whether you continue with managed care or deliver by fee-for-service or come up with a third model, is that the program has to be fully funded."

Chang said the evaluation showed that payments to MCOs were adequate, with four of the six consistently profitable.

While some MCOs dropped out, saying payments were too low, she said that was consistent with the experience of other states that have tried applying managed care to Medicaid. Overall, she said, the program was designed to save money, and its billion-dollar-a-year cost is about 2 percent below what the old system would cost, given inflation.

However, Chang said, the forums and focus groups had indicated that some doctors had been pulling out, leading to the proposal to increase physician rates.

She said this year's budget boost, which would raise rates beginning in July, was the first of several needed to improve physician reimbursement and "stabilize" participation.

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