In effect, the federal government supplemented the state Medicaid payment rate, raising it to the Medicare rate for two years, as an inducement for more primary care providers to provide care to Medicaid recipients as the provisions of the Affordable Care Act took full effect. Services provided by non-physician practitioners qualified for this enhanced rate when delivered under the supervision of a qualifying physician.
Sadly, the period for enhanced payment is now over. A six-month claim run-out period was allowed for claims for services in CY 2013-2014 as well as any adjustments or corrections, and the Kentucky Department for Medicaid Services posted an update to its website in mid-September, stating that “[t]he final cycle for the adjusted primary care payment rate, which includes the claim run-out period as well as the reconciliation, will process October 1, 2015.”
For providers who relied on these enhanced payments, the end of this program only brings into sharp relief the crisis in low reimbursement rates under the Medicaid program. The failure of Congress to extend what is referred to as the “Medicaid Primary Care Pay Parity” program may ultimately cause providers to begin to drop Medicaid patients in order to stay afloat. According to the Kaiser Family Foundation, fifteen states have chosen to continue the enhanced payment program out of state coffers, but Kentucky is not among them . Time will tell if the end of enhanced payment rates will affect the quantity of care available to Kentucky Medicaid recipients, but providers in Kentucky are likely already feeling the pinch.
Lisa English Hinkle
McBrayer, McGinnis, Leslie & Kirkland, PLLC
 42 CFR 447.400
 42 CFR 447.405
 Kentucky Department for Medicaid Services, http://chfs.ky.gov/dms (Last Accessed September 29, 2015)
 Kaiser Family Foundation, “The ACA Primary Care Increase: State Plans for SFY 2015” http://kff.org/medicaid/perspective/the-aca-primary-care-increase-state-plans-for-sfy-2015/ (Oct. 28, 2014, Last Accessed September 29, 2015)