Reforming Payment for Primary Care—It’s Not Just the Money, It’s the Payment System

Poor Medicaid reimbursement stands as a frequently cited cause of reluctance by many primary care practices to serve Medicaid’s expanding population.¹ With payment rates a fraction of those for Medicare and commercial insurance, most primary care practices find Medicaid reimbursement insufficient. The expansion of Medicaid eligibility by the Patient Protection and Affordable Care Act (ACA) creates an urgent need to engage more primary care practices and, if already participating, to expand their Medicaid roles. To encourage this expansion, the ACA² legislated a normalizing of Medicaid reimbursement so that the reimbursement matched Medicare fee-for-service (FFS) rates.