Senators want to extend and expand Medicaid payment rate increase

A new Senate bill would extend reimbursement parity for doctors who treat Medicare and Medicaid patients, and would also apply to nurse practitioners and physician assistants who treat women and children. The Ensuring Access to Primary Care for Women & Children Act (S.B. 737) is sponsored by Senator Sherrod Brown (D-Ohio) and Senator Patty Murray (D-Wash). The original provision was part of the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148), but was allowed to expire on December 31, 2014.

Medicaid provider shortage

In 2012, a report indicated that more than a third of physicians refused to take Medicaid patients because of the low reimbursement rates. Provider fees were temporarily hiked to match the reimbursements received for treating patients enrolled in Medicare. The expiration of the provision resulted in a substantial pay cut for primary care providers who were treating Medicaid patients. The bill’s sponsors are concerned that Medicaid enrollees, especially women and children, will be unable to find care in a timely manner if more providers refuse to see them. Following the expansion of Medicaid in many states under the ACA, almost 70 million Americans were enrolled as of December 2014.


The president requested a one-year extension in the 2014 budget proposal, but nothing has come from it. The senators feel that offering higher rates to providers will cut down emergency room visits for needs that could be easily addressed by primary care providers, which has been a serious problem for Medicaid programs. Research supports the idea that higher reimbursement rates increase appointment availability for enrollees. This extension does not come cheap, as CMS estimates come in as high as $11 billion for Medicaid.


This bill would go farther than the original ACA provisions, as ob-gyns, plus nurse practitioners and physician assistants who treat women and children, would also be included. This would impact a significant portion of Medicaid enrollees. In 2009, the majority of adult women enrolled in the program were considered of reproductive age. Women are more likely to regularly see an ob-gyn than any other type of doctor. Additionally, more people are seeking care from nurse practitioners and physician assistants as primary care providers become increasingly overloaded.