In a groundbreaking move, the Maryland Department of Health (MDH) has announced that it will be keeping the current Medicaid reimbursement rates for evaluation and management (E&M) services for enrolled Marylanders. This decision marks the first time that Medicaid’s rates paid to physicians are higher than those of Medicare for E&M visits. As a result, doctors can now provide the same level of care to Medicaid patients as they do to Medicare patients.
The pandemic led to a significant increase in Medicaid enrollment, with more Marylanders relying on this critical program to access healthcare. According to 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 healthcare access for all Medicaid recipients.”
E&M appointments include routine medical examinations, counseling, hospital visits (inpatient, observation, and emergency), nursing, home or residence services, and cognitive impairment assessment.
Typically, Medicaid payment rates to providers for E&M visits are lower when compared to Medicare. However, the recent decrease of E&M rates by 2% in the Medicare Physician Fee Schedule caused Medicaid rates to become slightly higher. The decision to maintain the rates is 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. According to MedChi CEO Gene Ransom, “the need to ensure robust Medicaid practitioner networks is inescapable, considering the impact on communities affected by lack of access to health care services as well as socioeconomic inequities and health disparities.”
Medicaid is the largest healthcare program in the United States, with over 1.7 million Marylanders currently enrolled. For more information about Medicaid eligibility and enrollment, please visit health.maryland.gov/mmcp.
