Linda Schwimmer

The New Jersey Medicaid program serves 2.1 million residents of our state, including half of all our children. However, Medicaid recipients continue to struggle with access to care, including primary care. Lack of access can have serious consequences.

At an event hosted by First Lady Tammy Murphy a few years ago, the young woman shared her experience of entering Medicaid and the need to switch from her familiar and trusted provider near her home because he was not taking Medicaid. She tragically lost her pregnancy because her new provider ignored her health problems.

Unlike commercial insurance and Medicare, too few physicians and other health care providers in New Jersey take Medicaid. The main reason is compensation. For primary care, including general pediatrics, the state Medicaid program pays providers about half the rate Medicare pays. The same goes for obstetrics. The policy of paying half the rate – for the same service – is unfair and unacceptable.

It also contributes to racial disparities in access, quality and health outcomes. Medicaid serves a racially diverse population: 66.6% of elderly Medicaid entrants identify themselves as black, Hispanic, Asian, or mixed race. Underpayment for health care that covers more racial minorities is unfair – and leads to less access, less choice, less cultural care and lower quality. This takes people to the emergency department for primary care, the most expensive and often the worst place for primary care.

This would improve access

Creating the basics of primary care with access for all in our state is very important to create a healthy population. During the height of the pandemic, we saw how valuable it was for patients to contact trusted healthcare professionals to discuss possible symptoms of COVID-19 and answer questions about vaccinations or other health issues.

Enhancing patient access and connecting to high-quality primary care was one of the 24 recommendations in action plan to exit COVID-19 released by the Institute of Quality last year. Increasing Medicaid’s investment in primary care is one of the most important steps we can take this year to make our state a healthy place for everyone. Evidence continues to show that health systems based on integrated primary care achieve better, more equitable health outcomes and are less costly.

People insured by Medicaid live all over our state. However, the state Medicaid program does not invest in primary care at a level that would encourage sufficient participation in the Medicaid program to meet state-wide demand. The state has already increased tariffs on federally qualified health centers to the Medicare level. The state must now raise tariffs on private primary care practices to encourage greater participation in the Medicaid program, especially in areas where other barriers, such as transportation, may affect access.

Correct resentments

To correct these errors, the Quality Institute is asking our legislature and the state governor to increase Medicaid’s primary care rates to 80% of Medicare starting fiscal year 2023. In fiscal year 2024, rates should be raised to Medicare levels and indexed to Medicare rising in the future.

The increase will focus on primary care, family medicine, general internal medicine and general pediatric practice across the state. Payments, like all reimbursement of health care costs, should be linked to uniform quality indicators to encourage and reward quality improvement.

Based on preliminary information about the state budget, we estimate that this proposal will cost about $ 200 million, and the state cost – $ 90 million. If the state had included a similar rate increase for midwives and midwives, government spending would have been an additional $ 40 million. These timely and equitable adjustments will improve access to high-quality health care, improve health equity and improve public health – all of which will have long-term benefits, including cost savings, for the state.

We need a continued commitment to equitable funding for primary care as the foundation of our Medicaid program. Otherwise, New Jersey will continue to perpetuate a structurally unjust health care system in which Medicaid students, most of whom identify themselves as minorities, have less access to high-quality care.

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