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65,000 health care providers cut from state Medicaid rolls

February 25, 2017

A provision of the Affordable Care Act that requires providers to revalidate or recertify their Medicaid reimbursement eligibility has caused 65,000 providers to be stripped from the federal program, according to a Modern Healthcare analysis.

Providers that enrolled in Medicaid before March 25, 2011, had to send in revalidation notices to the CMS on or before Sept. 25, 2016, or risk being dropped.

The ACA provision was an effort to curb fraud, waste and abuse in the program.

Modern Healthcare received data from 15 Medicaid agencies around the country. There is no nationwide tally of the total number of providers that accept Medicaid.

But to give a ballpark estimate on impact, Texas cut more than 28,000 of its 298,000 Medicaid providers, or nearly 10%.

Some states were successful in receiving revalidation notices, while others are just now evaluating their rolls because of staffing or technical limitations, according to Medicaid agency spokespeople.

States say many providers left Medicaid voluntarily. Medicaid has long been criticized for low reimbursement, often paying 60% of the Medicare rate for medical services.

Indiana, which dropped 3,226 providers, found many providers left the state, enrolled for a single patient or no longer wished to participate, according to Jim Gavin, a spokesman for the state’s Medicaid agency.

Washington and Tennessee officials made similar comments.

The Medical Association of Georgia learned that letters mailed to providers were returned because addresses were not updated in the state’s Medicaid system. It’s unclear how many providers were ultimately unenrolled. A state Medicaid agency spokeswoman did not return a request for comment.

Some providers worry that scrubbing doctors off state rolls will harm patients.

“The loss of any provider is dispiriting and will likely jeopardize patient access to care given concerns about network adequacy,” a spokesman for the Texas Medical Association said.

The American Medical Association and American Academy of Family Physicians said they haven’t heard complaints about access.

Improper Medicaid payments hit $30 billion in 2015, according to the CMS. Medicaid’s improper payment rate was 9.8% for 2015, nearly double what it was in 2013. The agency has yet to release its 2016 report on improper payments, but it had said previously it anticipates the rate to hit 11.5% for the year.

Improper payments are defined as any payment that should not have been made or that was made in an incorrect amount and are not all the result of fraud, though the tally includes fraudulent claims.


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