Medicaid Provider Reimbursement: Recent Changes to Pediatric, Obstetric, and Other Selected Fees

Back • Publication Date: May 23rd, 2008

Authors: Joachim O. Hero, M.P.H. and Mary Alice Lee, Ph.D.

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Physicians have been paid substantially less for treating Medicaid patients than for treating patients in Medicare or in the private market, which has meant that fewer physicians were willing to take on Medicaid patients and fewer families had access to care. To help resolve this problem, Connecticut recently increased reimbursement rates for Medicaid providers. These rate changes varied by type of service and patient.

Pediatric fees for well-child visits did not change, but a new policy permitting providers to bill for developmental screening in addition to well or sick visits would increase reimbursement by 6% for treating clients in their first three years of life. Fees for office visits increased on average 6 percent and on average over 25 percent for vaccines and immunization administration. Fees for office visits for adults and pediatric specialty care increased on average over 34 percent.

Medicaid fees improved in comparison to Medicare fees for Connecticut. Overall, pediatric rates in 2008 are at 85% of Medicare rates, up from 82% in 2006. However, fees for office visits for adults and pediatric specialty care are only at 57% of Medicare rates in 2008, up from 45% on average.