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No Child Turned Away, But For How Long? - by Dr. David Tayloe, Senior

Posted: 12/15/2015

No Child Turned Away, But For How Long?

By Dr. David Tayloe, Senior Fellow, NC Child

In 1977, I organized a solo pediatric practice in Wayne County and established an "open door" policy such that I turned no patients away, regardless of ability to pay.  I have been fortunate to recruit providers to my local rural community and today our practice serves over 20,000 Medicaid patients. 

Unfortunately, as pediatricians are being reimbursed less and less for providing Medicaid services, we have to make major decisions about how many Medicaid patients we can economically continue to care for in our practice. Since the late 1990's, Medicaid reimbursement rates have fallen and our legislature has passed a Medicaid reform bill that puts providers totally in limbo as far as their ability to predict the viability of a practice that cares for Medicaid-eligible patients. 

By contrast, the reimbursement rate for the most common office visits in Medicare, which provides health care for older adults, is 130% of the reimbursement rate for the same visits in North Carolina’s Medicaid program. Are Medicaid patients less valuable to society than Medicare patients?

If we have to limit the number of children on Medicaid we see in Wayne County, it’s unclear where else they can go to receive health care. We are the only pediatric practice in a county of 125,000 people. I know that pediatricians across our state and nation struggle ethically every day to justify taking care of patients who do not have the means to pay for services on-par with patients who have private insurance. 

The North Carolina Pediatric Society surveyed pediatricians earlier this year when the temporary bump in the reimbursement rate from the Affordable Care Act was being discontinued, and many pediatricians have scaled back their participation in Medicaid.

In another blow to children on Medicaid, the Supreme Court decided in Armstrong v. Exceptional Child Center, Inc., that pediatricians and other medical providers can’t sue states to ensure that they are being reimbursed sufficiently to care for the Medicaid population.

In light of this decision, we are working hard to persuade state and federal officials to adequately fund Medicaid services so that all children in our state and country have access to high-quality health care. For now, in Wayne County, all children do have access to care, and we’ll do our best to keep it that way. But in the long run, we need our elected officials to match our commitment to North Carolina’s children and fully fund Medicaid.

1 135 S. Ct. 1378 (2015) that the Medicaid statute does not provide a private right of action to providers to enforce state compliance with section 1902(a)(30)(A) of the Act in federal court.
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