Maryland holds Medicaid evaluation and management reimbursement rates steady, providing health equity opportunity
5/17/2023
Baltimore, MD – In a historic move, the Maryland Department of Health (MDH) today announced that it will maintain the current Medicaid reimbursement rates for evaluation and management (E&M) services for enrolled Marylanders. For the first time, Medicaid’s rates paid to physicians are more than Medicare for E&M visits, enabling doctors to provide the same access to care to Medicaid patients as it does to Medicare patients.
“During the pandemic, we saw significant growth in Medicaid enrollment, meaning more Marylanders are relying on this critical program to access health care,” said MDH Secretary Dr. Laura Herrera Scott. “The success in increasing provider participation stemming from this decision is not only financially sensible, but also essential for equitable health care access for all Medicaid recipients.”
E&M appointments include:
Routine medical examinations
Counseling
Hospital visits including inpatient, observation, and emergency
Nursing, home or residence services
Cognitive impairment assessment.
Typically, Medicaid payment rates to providers for E&M visits are lower when compared to Medicare. The Medicare Physician Fee Schedule recently decreased E&M rates by 2%, causing Medicaid rates to become slightly higher.
The decision to maintain the rates is just the latest effort to help Medicaid recipients obtain access to quality care. In 2021, the state of Maryland received $3.72 billion from the federal government for the American Rescue Plan Coronavirus State and Local Fiscal Recovery Fund to support the economic impacts of COVID-19. The increase of funds covered health insurance claims that rose during the pandemic, as well as provided additional pay to employees working in quarantine areas.
The Maryland State Medical Society (MedChi), which represents the interest of the state's physicians, believes the decision to hold the rate will allow practitioners to take on more Medicaid recipients as patients.
"Considering the impact on communities affected by lack of access to health care services as well as socioeconomic inequities and health disparities, the need to ensure robust Medicaid practitioner networks is inescapable,” said MedChi CEO Gene Ransom.
Medicaid is the largest healthcare program in the United States, with more than 1.7 million Marylanders currently enrolled. For more information about Medicaid eligibility and enrollment, visit health.maryland.gov/mmcp.
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The Maryland Department of Health is dedicated to protecting and improving the health and safety of all Marylanders through disease prevention, access to care, quality management and community engagement.
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