Is Your Practice a Medicaid Provider?

Fueled by the COVID pandemic, Medicaid enrollments across the country have increased significantly over the past year. In Colorado, enrollments are up 28%. 

Currently about 66% of Colorado physicians accept Medicaid. Should your medical practice be one of them?
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Is Your Practice a Medicaid Provider?

Surge in Medicaid Enrollments
​Expected to Continue

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Fueled by the COVID pandemic, Medicaid enrollments across the country have increased significantly over the past year. In Colorado, enrollments are up 28%. Almost 1.5 million Coloradans are currently served by Medicaid. And the Colorado Department of Healthcare Policy & Financing (HCPF) estimates that an additional 427,000 Coloradans could enroll in the program by the end of June.

Currently about 66% of Colorado physicians accept Medicaid. Should your medical practice be one of them?
​

More Patients Eligible

Last spring’s high unemployment rate enabled more Americans to be eligible for Medicaid than ever before. Dramatic enrollment increases were confirmed by all the primary health insurance companies who serve Medicaid patients.

There are several reasons why this trend is expected to continue throughout 2021:​

• Typically, an increase in Medicaid enrollments lags behind that of other governmental aid — such as food stamps and unemployment — because people tend to focus on the immediate needs of food and shelter.
• Likewise, there is often a lag between job loss and loss of employer-based medical insurance. 
• Non-urgent medical visits have been postponed during the pandemic. These visits often prompt Medicaid-eligible patients to enroll in the program, as healthcare providers often help their patients apply.

As a result, healthcare providers can anticipate that Medicaid enrollment will continue to increase in the coming months.

Medicaid provides an essential service, allowing millions of Americans to receive healthcare services which they otherwise could not afford. With programs managed at the state level, individualized needs are met.

Medicaid-to-Medicare

Fee Index

The Medicaid-to-Medicare fee index measures physician fees relative to Medicare fees and varies by state. Doctors in states with higher ratios are more likely to accept new Medicaid patients.

According to the Kaiser Family Foundation, the overall national Medicaid-to-Medicare index is 72%; Colorado scores are higher at 80%.

​Getting Paid

Colorado healthcare providers can be reimbursed for Medicaid services through managed care plans, on a fee-for-service (FFS) basis, or both.

Managed Care
Since 2011, the vast majority of Colorado Medicaid beneficiaries have been enrolled in managed care plans. Providers are paid a monthly per-member fee in addition to the standard Medicaid fee-for-service (FFS) reimbursement. The difference is that the managed care fee provides upfront fixed payments for anticipated use of covered services, as well as administrative costs and profit.
 
The state of Colorado is currently serviced by two Managed Care Organizations (MCOs): Denver Health Medicaid Choice and Rocky Mountain HMO. Healthcare providers have the option of contracting with one or both of these MCOs to treat their Medicaid patients.

Fee for Service
With FFS, the state pays healthcare practitioners directly for each Medicaid-covered service provided. Once managed care reimbursement for a service has been exhausted, FFS claims can be submitted. FFS rates are tailored to pay only for those services that an eligible patient has specifically received. In Colorado, that figure is around 80% of the provider’s standard fee. (See box, “Medicaid-to-Medicare Fee Index.”)

Benefits to Accepting Medicaid

There are several advantages to becoming a Medicaid provider, specifically:​

​You become part of the solution. 
​Medicaid beneficiaries have much better access to care than the uninsured population. Which means they’re less likely to postpone or go without healthcare because of the cost.  Nationally, more than 43% of all Medicaid beneficiaries are kids. (At least 40% of all Colorado children are beneficiaries of the program.) Because of Medicaid, these children can receive annual checkups, necessary vaccines, and appropriate medications whenever needed. It also covers disadvantaged families who require special care.​

Access to a large potential patient base. 
There are households within every community that qualify for the program. For example, as of September 2020, more than 77 million people — over 23% of the U.S. population — were enrolled in Medicaid. What’s more, every state publishes a list of participating providers, so there’s no need to advertise. If you’re establishing a new practice, this built-in customer base can be particularly helpful.

​Guaranteed payment. 
Medicaid provides a guaranteed stream of income which can sometimes be even more reliable than private insurance. In fact, Health First Colorado claims to pay faster than most private payers, through weekly claims that are deposited directly into a provider’s business account.

​EHR incentives.
The EHR Provider Incentive Program provides financial support for Medicaid providers who adopt or upgrade their EHR systems. ​

Colorado’s Medicaid Milestones

1969 – Colorado authorizes Medicaid program.

1985 – Colorado expands managed care in Medicaid by adopting Home and Community Based Services (HCBS) program.

1998 – Colorado enacts Children's Basic Health Plan Plus (CHP+).

2013 – Colorado approves Medicaid expansion through the Affordable Care Act (ACA)

2014 – Colorado introduces integrated care for Medicaid and Medicare.

2020 – Colorado witnesses a surge in enrollments fueled by COVID pandemic.

Why Don’t All Providers Accept Medicaid?

Considering all the advantages, why don’t all healthcare providers accept Medicaid? There are two primary reasons:

• Medicaid reimbursements are 28% less than those of private insurance nationally, and timing on payment is not guaranteed. Also, fees for missed appointments must be waived.​
  
• Because of additional documentation required for Medicaid reimbursement (as opposed to private insurers), administrative overhead can be higher. In addition, pre-authorization may sometimes delay delivery of treatment, so more appointments may be required. 

You Decide

Is Medicaid a good fit for your practice? Only you can decide. But with enrollments at an all-time high and still climbing, now may be a good time to consider it.

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Sources:
​Featured Image: Adobe, License Granted
Center on Budget and Policy Priorities
Kaiser Family Foundation
Colorado Department of Healthcare Policy & Financing
Health Research Funding
Checkpoint EHR

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