Expanding Health Care Coverage

Project Title

Increasing Primary Care Rates and Access to Medicaid Providers in New York State

Grant Amount


Priority Area

Expanding Health Care Coverage

Date Awarded

August 15, 2011


Outside New York State





Medicaid has long reimbursed physician services at a lower rate than private payers and Medicare, discouraging physician participation.

The discrepancy in rates is a major reason why many physicians do not accept Medicaid and why a declining number of primary care physicians (PCPs) are accepting Medicaid patients. Resulting from the provisions of the Affordable Care Act (ACA), there will be an influx of newly insured people who will need doctors to care for them. To create an adequate supply of doctors, the ACA requires that Medicaid reimburse PCPs at parity with Medicare rates in 2013 and 2014. Later this year, the Federal government will develop and issue regulations that further define the parameters of the rate increase. To inform these guidelines on a national level, NYHealth awarded the Center for Health Care Strategies (CHCS) a grant to work with a number of states, including New York, to: 1) develop a coordinated response to draft regulations to help make them workable in practice at the state level; 2) develop a set of core measures that the Federal government and states could use to track the effects of the rate increase; and 3) provide states with high-level roadmaps for implementing the rate increase.

Under this grant, CHCS helped address numerous technical and policy issues underlying successful implementation and developed strategies for sustaining the rate increase beyond 2014. Among the complex issues addressed were: 1) identifying the primary care services that are covered in the increase; 2) identifying providers and places of services eligible for the increase; 3) understanding baseline primary care rates; 4) implementing a new fee schedule and capitation rates; and 5) sustaining the rate increase beyond 2014.