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SHM Sends Letter to House and Senate in Support of Extending Medicaid Parity

September 15, 2014

SHM's Policy Efforts

SHM supports legislation that affects hospital medicine and general healthcare, advocating for hospitalists and the patients they serve.

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The Honorable Patty Murray 
U.S. Senate 
Washington, D.C. 20510

The Honorable Sherrod Brown
U.S. Senate
Washington, D.C. 20510

Dear Senators:

The undersigned organizations, representing internal medicine and related subspecialties, applaud you for your efforts and leadership in introducing the Ensuring Access to Primary Care for Women & Children Act, S.2694. This legislation will help ensure access to vital primary care services delivered by primary care and related subspecialty physicians for many of this nation’s most vulnerable citizens, by extending current-law payment rates under Medicaid for certain primary care and immunization services to at least the level of Medicare through 2016. The undersigned organizations fully support this legislation, as described below.

Ensuring sufficient payment for primary care services and vaccinations, and to the physician specialties and subspecialties that deliver them, is essential to ensuring access for the 65 million women, men, adolescents and children enrolled in Medicaid. Well-established research has shown that low Medicaid payment, which in many states has historically been well below the costs of delivering care, has been a major reason physicians are reluctant to participate in the program. As a result, the Medicaid program has long-struggled to attract participating physicians, making it difficult for low-income children, parents, qualifying adults, and elderly Medicaid enrollees to find a primary care doctor or a medical or pediatric subspecialist when they have specialized healthcare needs. Patients who do not have an established relationship with a primary care physician or related subspecialist often will delay getting needed care, and when they do obtain care, it may be from an emergency room or urgent care clinic. Studies show that access to primary care is consistently associated with better outcomes and lower costs.

This legislation will extend and ensure continued funding of what is often referred to as the Medicaid Primary Care Pay Parity Program under current law. It ensures that physicians practicing in the specialties of family medicine, pediatrics, and internal medicine as well as related internal medicine and pediatric subspecialists continue to receive Medicare-level reimbursement rates for providing primary care and immunization services to patients enrolled in Medicaid. Maintaining access to primary care and related medical and pediatric subspecialists, by ensuring comparable rates under Medicare and Medicaid for these services, is especially critical at a time when the population enrolled in Medicaid is surging. These comparable Medicaid payments serve as incentives for eligible physicians to maintain or increase their Medicaid patient population in all states, whether or not a given state has elected to expand its Medicaid program. A recent survey of a representative sample of members of the American College of Physicians found that almost half of those participating in the current Medicaid Primary Care Pay Parity Program would have to reduce the number of Medicaid patients they see, or drop out of the program altogether, if the program is allowed to expire at the end of this year.

This legislation also includes physicians practicing obstetrics and gynecology as qualified specialists, subject to the eligibility requirement that at least 60 percent of their Medicaid billings consist of primary care services as defined under current law. We support this policy.

We appreciate your continued leadership on this issue and will make every effort to help advance this important legislation, which is a key priority for the College. We stand ready to serve as a resource and welcome the opportunity to work with you going forward.


American Academy of Allergy, Asthma, and Immunology
American Association for the Study of Liver Diseases
American Association of Clinical Endocrinologists
American College of Allergy, Asthma and Immunology
American College of Cardiology
American College of Chest Physicians
American College of Physicians
American College of Rheumatology
American Medical Directors Association
American Society for Blood and Marrow Transplantation
American Society of Hematology
American Society of Nephrology
American Thoracic Society
California Medical Association
Endocrine Society
Infectious Diseases Society of America
Joint Council of Allergy, Asthma and Immunology
Renal Physicians Association
Society for Adolescent Health and Medicine
Society of General Internal Medicine
Society of Hospital Medicine