Florida physicians made the argument for years: The state's Medicaid payment rates have been so low that many doctors stayed away from the program.
But the federal Affordable Care Act provided a temporary solution. In 2013 and 2014, the law calls on the federal government to spend hundreds of millions of dollars to boost the pay of primary-care physicians who provide much of the treatment for low-income Floridians enrolled in Medicaid.
Now, however, Florida lawmakers and doctors face a dilemma. The federal government will stop covering the full cost of the physician pay increases at the end of next year. And that means Florida taxpayers would have to pick up part of the extra cost if the pay hikes are going to continue, starting in January 2015.
The Florida Medical Association, an influential physicians group, has started lobbying lawmakers to include money in the upcoming 2014-15 fiscal-year budget to prevent doctors from falling back to lower payment rates. But it wouldn't come cheap: The FMA estimates the state's cost at roughly $135 million -- and a state report last year put the potential cost even higher.
Monte Stevens, an FMA lobbyist, told senators last week that physicians will consider the payment rates in deciding whether to serve Medicaid beneficiaries.
"Physicians are no different than any other small-business owner in the state,'' Stevens told the Senate Health and Human Service Appropriations Subcommittee. "They don't make decisions about their business arrangements in a two- or three-year business cycle. They look at the long term."
It remains unclear, however, whether lawmakers and Gov. Rick Scott will support spending the money. The Agency for Health Care Administration, which is part of the Scott administration and oversees Medicaid, did not include the additional money in its budget request for the 2014-15 fiscal year.
Also, supporters of spending the money face questions about whether the higher pay is attracting more physicians to treat Medicaid patients. While the increased federal payments were slated to start in January, doctors did not start seeing additional money until this summer and fall because the state needed approvals for how the funding would flow through.
While physicians will receive the additional money retroactively, the delays make it harder to determine whether higher payment rates are serving as an incentive to draw more doctors to the program.
"It's pretty early to tell because the money has only recently started flowing. We don't have necessarily a long enough track record for us to tell whether or not this has had an impact, but we certainly think it may,'' said Justin Senior, AHCA's deputy secretary for Medicaid.
Senate Health and Human Services Appropriations Chairwoman Denise Grimsley, R-Sebring, said in an email Thursday she hopes lawmakers will see data in the coming months about whether higher payment rates are attracting doctors to serve Medicaid patients.
"The goal of the increase, of course, was to encourage more providers to serve Medicaid recipients,'' Grimsley said in the email. "As HHS chair, to consider maintaining the increase with state dollars, I want to make sure the objective of increasing access for Medicaid recipients is being met."
The Affordable Care Act, better known as Obamacare, called for Medicaid rates to be on par with higher rates paid in the Medicare program. Stevens pointed last week to a study that found Florida's Medicaid program in the past paid primary-care physicians roughly half of the Medicare rates.
The current, fiscal 2013-14 budget includes about $677.7 million in federal money to cover the increased Medicaid payment rates. The federal government will continue paying the full cost through December 2014, which is halfway through the state's 2014-15 fiscal year. Florida would then have to start paying part of the cost for the second half of the fiscal year, with the federal government also paying a portion.
