Many psychologists and neuropsychologists do not currently take Medicaid. Several states do not allow psychologists to be independent Medicaid Providers. Other states' payments are low enough where eligible clinicians simply opt out, or other barriers such as restriction of scope of practice exist which discourage Medicaid participation.
Why will Medicaid become important to psychologists with healthcare reform?
The Affordable Care Act requires that everyone obtain health insurance. As the Healthcare Exchanges launch in 2014, two factors will lead to an increased number of Americans on Medicaid. 15 states have opted to expand their Medicaid eligibility. 10 other states are now leaning towards expansion.
At the same time, the percent of Americans with Employer Sponsored Insurance (ESI) is declining. This means that many more Americans will have to enter the Exchanges to purchase healthcare. Medicaid products will become an option for many families that previously utilized private insurance provided by their employers.
How will this effect most psychologists' and neuropsychologists' practices?
Referral streams. As more lives in a given geographical region are covered by Medicaid products, clinicians who do not accept Medicaid will see a reduction in their pool of potential referrals. The number of people who have access to high quality psychological and neuropsychological services will decline. In states where psychologists and neuropsychologists are barred from being Medicaid providers, advocacy efforts need to be directed toward adding psychologists to eligible providers.
Payment reform and Medicaid
Medicaid has traditionally operated on a fee for service basis. States now vary in payment structures, with managed care, bundled payments, global payments, and medical/ health home payment. Medical Home payments may be structured as an additional per patient per month fee above and beyond fee for service costs, or reimbursement for coordination services that are not typically covered with traditional fee for service payments.