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Spokane, Washington  Est. May 19, 1883

Washington Legislature needs to close Medicaid funding gap

Brian Seppi M.D

Uncertainty is not something that anyone wants in their health care. When you are ill, you need the ability to get care from a primary care provider who knows you and is able to work with you to ensure you receive the care you need. Unfortunately, for those who are the most vulnerable and receive insurance through Medicaid, access to a primary care provider has not been the norm.

Recent Medicaid expansion helped make access to insurance coverage more reliable across the state. It has allowed many without insurance the ability to get coverage for the first time. Prior to passage of the Affordable Care Act, many primary care providers reluctantly decided against taking on new Medicaid patients because Medicaid pays only 66 percent of what would be paid to provide the same service to a senior on Medicare. Medicaid payments fall far short of covering the cost to provide that care.

The result was that many primary care providers did not take new Medicaid patients. Without access to quality primary care, preventable emergency room visits increase while health outcomes worsen, costing the state money, productivity and lives. Health care reform addressed this problem by putting Medicaid rates for primary care services on a par with Medicare rates. This improved funding allowed primary care providers to take on new Medicaid patients and cover overhead expenses in their practices. The problem is there is a six-month funding gap where Medicaid rates will be reduced back to their original rate due to differences in the federal and state funding calendars.

The Legislature must address this gap in the current supplemental budget. Washington’s fiscal year doesn’t begin until July, and federal funding ends in December. That leaves a six-month gap needing immediate attention before the next biennial budget. This investment is critical to improve access to primary care, which will ultimately lower overall health care costs. We have a shortage of primary care physicians, and this funding gap makes it more difficult to recruit the physicians we need to care for our Medicaid population. This will mean new Medicaid patients will face barriers to receiving care, or lose continuity of care, which is especially harmful for people with chronic conditions such as diabetes, coronary heart disease and congestive heart failure.

Primary care providers need a long-term state commitment to fair Medicaid compensation to be able to provide efficient, reliable care to Medicaid patients.

The Legislature must act in this session to clean up this discrepancy in the funding package. This action will provide certainty for Medicaid patients so they can receive the care they need to be more productive, healthier and make a positive impact in our communities.

Brian Seppi, M.D., internal medicine, is the president-elect of the Washington State Medical Association.
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