Genny Kenney was in town yesterday talking about "Fifty Years of Medicare and Medicaid: Where Are We Headed?" and I can't stop thinking about attempts to push Medicaid to be more like Medicare. I would argue that this has been attempted more by trying to transform Medicaid than by trying to transform Medicare, but it is still interesting to monitor the attempts.
One striking attempt was the ACA Medicaid fee bump offering a two year maximum fee bump to Medicaid primary care providers to Medicare reimbursement levels. Given the incredible variation in Medicaid provider reimbursement rates, this is more of a biggie in some places than others. I'm looking at you California.
I have written elsewhere about how administrative delays reduced the length of California's experiment with the Medicaid fee bump to at most an 18 month interval. Of course, this is a time interval that may not be able to teach us much of anything anyway.
What is interesting is the number of states that want to continue the experiment. Fifteen states propose to continue the Medicaid fee bump. As far as I can tell, none of them propose to extend it to specialty care where, as Genny Kenney pointed out, the real bottleneck, in Medicaid access occurs.
This year I showed my health law students the cinema verite documentary "The Waiting Room." It is hard to forget the scene of the emergency department doctor begging favors on the telephone to obtain a neurology appointment for a thirty something young man who is weeks post stroke but has yet to be seen anywhere but the ED.