OAFP Communications and Advocacy Efforts on Medicaid Payment Parity

Randy Wexler, MD, Advocacy ChairAnn Spicer, EVP

In Ohio, Medicaid PCP reimbursement is 59% of Medicare rates

Real $$ on that tableFPs lacked information on:

enhanced payment attestation process

Medicaid outreach insufficient

Medicaid Payment Parity in Ohio

OAFP Goals

Make OAFP members aware of enhanced payment and attestation process

Advocate for workable attestation process

Help OAFP members with attestation and payment problems

Unfavorable Environment

Early comments of Medicaid personnel:What’s the big deal?Mortgaging my children’s future – feds can’t

afford this“You people” are always complaining

Identified Gaps; Sought to Fill

Outreach Process uncertaintyTechnology issuesProcess issues

OAFP Maintained Problem List

Ask OAFP members to let us know if they attested and weren’t on approved list

Gave us the ammunition to use to convince Medicaid director of problems

Medicaid pledged to work with us on problem resolution

Slow, difficult process

Touched Members in Positive Way

Generated more calls and emails than any issue in recent memory

Touched members we have not had any contact with before

Made some loyal friends for lifeEnded every conversation with, “thank

you for being an OAFP member.”

Member Response

Thank you for working so hard on this and keeping me updated! 

Thanks for your assistance, patience, and hard work. I really appreciate.

We appreciate the value of OAFP membership.

Member Response

Thanks for dogging this on my/our behalf.

Thank you for your persistence and assistance with this! 

If you are ever in NW Ohio I would be delighted to buy you an adult beverage. Thanks for all your help.

Status

Have eliminated most of our problem list

PaymentMost have still not received paymentFFS Medicaid paid at enhanced rateManaged care to receive $ in late Oct. to

begin paymentsFiguring out retroactive payments scheme

Delay is Harmful

Purpose of enhanced payment was to increase numbers of PCPs seeing Medicaid patients

Still haven’t been paid so it is likely that increase hasn’t happened

Will be used against us when we argue for continuation of enhanced payment beyond Dec. 31, 2014

Lessons Learned

Having input into the implementation of legislation is just as important as having input into the legislative process itself.

Advocacy journey doesn’t end when a bill is signed into law.