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Medicaid Payment Increase

  Sign Up for the ACA 2013-2014 Medicaid Payment Increase!

The Patient Protection and Affordable Care Act (ACA) includes an historic investment to expand access to Medicaid for children, and the AAP wants to make sure you know about it: As of January 1, 2013, Medicaid payment rates are raised to at least Medicare rates for primary care and immunization services.

View this state chart to learn where your state stands.

Eligible pediatricians must sign up (“self-attest” to eligibility) to receive the increase in payment. There is still time to apply!

Some states have imposed deadlines for signing up for the increase to allow for payment retroactively to January 1, 2013. Pediatricians and other eligible physicians who self-attest after a state’s deadline will still receive the increase in payment moving forward; it just will not be retroactive to the beginning of the year.

All eligible pediatricians are encouraged to sign up as soon as possible! Please spread the word to your colleagues.

Step 1: Find out if you are eligible

  • Pediatricians, internal medicine physicians and family medicine physicians are eligible for the payment increase.
  • Pediatricians and pediatric subspecialists recognized by the American Board of Pediatrics (ABP), the American Board of Physician Specialties (ABPS) or American Osteopathic Association (AOA) and their relevant subspecialty boards are eligible, but must self-attest to the state by virtue of having such Board certification.  
  • Other physicians can qualify without Board certification if at least 60% of all of the Medicaid services they bill are for Evaluation & Management (E/M) and vaccine administration codes specified for the payment increase. 
  • Physicians in managed care arrangements as well as physicians who are employees are eligible. Depending on your state’s rules, services provided by allied health professionals that a pediatrician personally supervises also qualify for the increase.
The increase applies to E/M and immunization services and runs from 2013-2014. The Academy will aim to extend the provision into a permanent investment in children’s health.

Step 2: Sign up to receive the increased payments

  • Sign up for the increased payments with your state. Please visit this chart that includes state notifications, self-attestation forms, and other resources on where your state stands. Self-attestation forms must be signed by each physician seeking increased payment and sent to the state per state instructions.
  • Of note, not all states have yet created self-attestation forms. If your state does not yet have a form or other means for you to sign up, it will be releasing this information soon. Contact your state AAP chapter’s executive director or speak to your state Medicaid office to learn of your state’s plans for implementing the payment increase and how to sign-up as soon as possible.
Step 3: Turn to the AAP to help
The AAP has numerous resources on the ACA 2013-2014 Medicaid payment increase, including the following:

From the Division of State Government Affairs:

From the Department of Federal Affairs:

  • Fact sheet summarizing the key provisions of the payment increase.
  • FAQ guide outlining the payment increase in more detail, including a breakdown of the payment increase by subspecialty. 
  • AAP News article on what the Medicaid payment increase means for pediatricians and guest AAP News article by Department Health and Human Services Secretary Kathleen Sebelius on partnering with pediatricians to implement the increase.

If you have questions on how the increase will take effect in your state, please do not hesitate to contact the AAP Division of State Government Affairs at stgov@aap.org or 800/433-9016 ext. 7799.

If you have questions on the Academy’s federal advocacy efforts to make the payment increase as comprehensive as possible for children, please reach out to the AAP Department of Federal Affairs at kids1st@aap.org and 800/336-5475.