Medicaid Matches Medicare Rate for Dual Eligible Providers

Health Care

4 doctorsThe Health and Human Services Commission resumed paying 100% of the Medicare rate for health care for dual eligible individuals until they reach the Medicare deductible limit, as of Jan. 1, 2013. About 300,000 low-income Texans are considered dual eligible, qualifying for both Medicare and Medicaid. The Medicare deductible for 2013 is $147.

HHSC stopped making Medicaid payments during 2012 for Medicare deductibles and Medicare cost-sharing copayments based on instructions from the Texas Legislature to help balance the state’s budget. The new change reinstated payment of deductibles to doctors and other providers by matching the Medicare rate. For example, if the Medicare rate for a service was $100 and the Medicaid rate was $75, the doctor only got $75 from Medicaid during the deductible period last year. Under the revised policy, Medicaid will pay the full $100 during this period.

Coverage of copayments has not been restored, and many people are encouraging legislators to address it during the current session.

In related news, a Texas Medical Association survey last year found the lowest-ever patient acceptance rates for Medicare and Medicaid. The number of Texas physicians treating new Medicaid patients fell to 31% in 2012, from 42% in 2010. In Medicare with its higher reimbursement rates for doctors, the acceptance rate fell from 66% in 2010 to 58% in 2012.