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A relative who is about to open a private practice in New York for the first time is considering whether to accept Medicaid plans from patients. Does anyone have any insights whether it is worthwhile to enroll in various Medicaid managed care plans or Child/Family Health Plus as an in-network provider?
Yes a doctor should, because: chessed.
There are really two questions here. First, would it make sense from an economic perspective based on the current Medicaid reimbursement rates from the various network/PPO insurance providers? The second question is whether there is a moral or ethical imperative for physicians to make their services available to the Medicaid population given that many practices will not accept patients in this group? The answer to the first question is based on the facts of the specialty, type of practice, etc. The second question is entirely a personal decision for a health care professional. Many reach a compromise and limit the percentage of their patients who are on Medicaid.
Unless she plans to have tremendous volume, it’s not worth it.
LB:
Chessed? ithout a question, that would be a wonderful thing. But the physician, or other health care professional, entered the field in order to provide parnosoh for his family. To establish himself in a manner that cheats on the bottom line, offering his services for far less than they are worth, might provide much less income than planned. I am not talking about doctors going on expensive vacations or driving fancy cars. I am talking about paying tuitions.
I cannot judge the doctor who calculates that he can fill his practice with patients whose reimbursements are greater than what Medicaid offers. His obligation to do chessed might lie elsewhere, not in his decision about how to run his practice. I know of doctors who extend their services far beyond the billables, and are huge donors to the finest tzedokos in the community. Are we to judge just how someone should do chessed? That does not lie in my domain, and I strongly believe that us commonfolk lack the insight into Divine calculations that would be needed to judge here.
Depends on which state the person is going to practice in. Every state has different rules and regulations. In NYS, the provider not only has to apply to be s Medicaid provider they Asldo have to enroll with the individual MCO to accept their patients. Every MCO has s different reimbursement schedule and overall it may not be worthwhile. As to chested, s doctor can waive copayments or other fees to patients to fulfill chesed.
iac: A) Most insurance plans contractually do not allow doctors to waive co-pays and deductables and B) Medicaid doesn’t have co-pays or deductables altogether (at least in NY, where the OP is asking about), so waiving them doesn’t help Medicaid patients.
iacisrmma -“Every MCO has s different reimbursement schedule and overall it may not be worthwhile.”
When you do Chessed – it’s not for gain in this world, but for the next!
“As to chessed, s doctor can waive copayments or other fees to patients to fulfill chesed.”
If you do that – you are breaking the law! Nowadays they prosecute insurance fraudsters.
It deends on the neighborhood. If its a neighborhood with mainly medicaid clients it might be a necessity. If its an upscale neighborhood it might be optional.
If your relative is going into Pediatrics, accepting Child Health Plus is almost a necessity in NY. Many people qualify for CHP as the allowable income is very generous, although the premiums vary accordingly.
Accepting medicaid patients does not contradict accepting private insurance patients. So what does it have to do with parnassah? If anything they are broadening their spectrum.
Besides, most doctors will give less time for medicaid patients so they do work around that problem of less fee. Not saying its right or wrong but at least they see them.Mammele: CHP isn’t Medicaid.
“Besides, most doctors will give less time for medicaid patients so they do work around that problem of less fee. Not saying its right or wrong but at least they see them.”
How do doctors give less time to Medicaid patients than to their other patients?
most doctors starting out have big medical school bills to pay off.
waiving a copay is not insurance fraud. besides, billing for a copay, but not pursuing debtors , is not illegal.
Because Medicaid patients don’t have copays ( well, there is an $3 Outpatient copay ) they tend to make appts for minor ailments ( ie 100 degree temp ) that other patients won’t. As a result they can crowd out patients with better paying insurance.waiving a copay is not insurance fraud
It can be considered an illegal kickback, or a violation of the contract with the insurance company (and therefore fraud).
How do doctors give less time to Medicaid patients than to their other patients?
By checking them more quickly (therefore less thoroughly) and spending less time answering questions.
“By checking them more quickly (therefore less thoroughly) and spending less time answering questions.”
The doctor will stop answering his questions after a set amount of time?
No
The doctor is not a gemach. he is running a business. he is entitled to his fee. it is not mine or your place to tell how and when to perform chessed.
Joseph: the OP inquired about Child Health Plus as well. Additionally, you are sort of wrong. It’s one mish-mash with Medicaid. Below is from a 2012 article in Urban, I don’t think the two are more separate now, if any one besides Joseph is interested…
“Child Health Plus is administered by the New York State Department of Health (DOH), the single State agency that also has primary responsibility for managing Medicaid. This joint program administration by DOH has facilitated New York’s alignment of CHIP and Medicaid policies and operations over time, to the extent that the two programs are now, broadly speaking, quite comparable and better integrated than they have been at any point in the past. CHPlus continues to oversee its innovative community-based application assistance program—called Facilitated Enrollment—that supports both CHIP and Medicaid enrollment, and is demonstrably effective in leveraging the marketing expertise of public and private managed care organizations to facilitate families’ enrollment of their children into coverage, and to maintain continuity of coverage through effective renewal strategies. On the service delivery front, statewide managed care systems that possess nearly identical networks for CHIP and Medicaid appear to provide children with robust access to care—especially primary care—and also minimal disruptions in care as children move between the two programs.”
Hope you gained some perspective.
And thanks Mods.
Mammele: Thank you for that research. Do doctors get reimbursed at the same rate for CHP patients at they do for Medicaid patients? (In which case, apparently, the only difference between NY Medicaid and CHP is the costs for the enrollee/consumers.)
Medicaid Patients- yes, doctors will often rush the visit and get up very soon signaling that your session is over. Its basically cutting corners as it allows them to compensate for the small fee they collect from medicaid.
Same with dentists, even worse. They will sometimes rush bigger treatments like extracting a tooth over fixing it with a root canal or similiar since they will get paid better for the extraction rather than the whole treatment. Also might use less quality materials for treatments.
Some people on medicaid go in for a cleaning and leave with less clean teeth than if they would’ve just brushed.In general you have to be careful with doctors skipping to more serious treatments than necessary (MONEY), although with medicaid they try less to avoid them.
Good doctors are careful not to know what type of insurance the patient has so that they do not act with bias. The is the practice most of my practitioners have used, some have gone out of their way to do so.
“Good doctors are careful not to know what type of insurance the patient has so that they do not act with bias.”
Usually they are aware or find out somehow whether intentional or unintentional. They also have small talk with you which sometimes reveals to them your working status, plus if you need a referral from them they may ask or you might volunteer info on your insurance type so that you can actually go see that referral. Same for prescriptions. It eliminates time wasting.
Litvishechossid
“Same with dentists, even worse. They will sometimes rush bigger treatments like extracting a tooth over fixing it with a root canal or similiar since they will get paid better for the extraction rather than the whole treatment. Also might use less quality materials for treatments.”
You realize this statement is inherently contradictory
An extracted tooth can only be billed for the extraction.
I have several dentist friends and I can assure you that they get reimbursed more for root canals then extractions. Any one who has had these procedures knows this
Also, do you really think that doctors/dentists have two drawers, one with expensive equipment for the good patients and one with the cheap stuff?!
It doesn’t work like that. You really have no clue.“It doesn’t work like that. You really have no clue.”
Agreed. I was going to say that as well. And considering how many people he is painting incorrectly with that broad brush he should tread more carefully.@mentsch1- What I meant was that for their work and effort, extracting a tooth would be more worth it for them than what they would get paid by medicaid for a root canal besides for the hassle of submitting proofs that its necessary.
And dentists do often rush through a treatment when they dont get paid enough.“And dentists do often rush through a treatment when they dont get paid enough.”
Find a better dentist. So many do not.
Im not saying all doctors and dentists are the same, but its pretty natural for someone to put in less effort when they arent getting paid accordingly. In any profession not just medical.
If you were hired to clean a kitchen for $150, or clean a kitchen for $20 and expected to put in the same amount of work and time, wouldnt you cut corners?Litvishe
The first part of your statement is still wrong
Addressing the second (rushing). I made this point in a similar thread. Just like every other profession a doctor has to make a parnasah and pay the bills. In a Medicaid practice the reimbursement is far less then private insurances. the only way a doctor can stay in business is by volume, seeing more patients per hour . If you have A crummy insurance you are in essence paying your doctor below the appropriate fee for any given procedure and you can not expect the same service as you would get at a concierge practice.For some doctors, it simply isnt worth their time. I am aware of several pediatricians in Brooklyn, that do not accept United Healthcare Community Plan (a medicaid plan), for example – there are other plans – because the reimbursement is a joke, recommended tests are often second guessed and the bottom line is the benchmark for all measurable service levels by UHC.
DY – “By checking them more quickly (therefore less thoroughly) and spending less time answering questions.”
litvishechossid -“Medicaid Patients- yes, doctors will often rush the visit and get up very soon signaling that your session is over. Its basically cutting corners as it allows them to compensate for the small fee they collect from medicaid”STOP with the Lying!
I, as a medical guy, also use a primary doc. Most of the Frum community don’t use him, because his partners are Goyim. They go to the Frum only Practiceses.
My doc takes Medicaid. He is better than all the Frum practices. He treats all pts. the same.
Unfortunely your additudes’ are prevalent in the Frum community!A large portion of frum families have Medicaid or Child/Family Health Plus.
Joseph, you meant a large portion of kollel and chassidishe ( i.e. KJ, New Square ) families, not all frum families.
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