U.S. Rep. Jeff Denham (R-CA), the California Medical Association (CMA), and the Stanislaus Medical Society (SMS) have proposed a demonstration project in the congressman’s California district to study certain healthcare access reforms that could eventually also benefit low-income Americans around the country.
“Access is the biggest healthcare problem we have in the Central Valley,” said Rep. Denham on Oct. 17. “This project will improve physician reimbursement rates and bring more doctors and better care to our community.”
Specifically, the proposed Center for Medicare and Medicaid Innovation (CMMI) project would study reform of non-Federally Qualified Health Center (FQHC) Medicaid physician payment on access to primary care and specialty physicians in Stanislaus County, Calif., which has a high concentration of Medicaid patients, according to the CMMI Medicaid Value-Based Payment Model Proposal released by the congressman’s office this week.
Rep. Denham worked for 18 months on coordinating with both the CMA and SMS to develop the pilot program, according to the lawmaker’s office, which noted that the pilot program could significantly improve access to healthcare for Medi-Cal patients in Stanislaus County.
Almost 45 percent of the county’s residents are currently Medi-Cal enrollees who lack access to timely health care, largely because physicians in the state receive low reimbursement rates to treat them, according to Denham’s statement.
Under the pilot program, Medicaid reimbursement strategies would be examined to determine how best to spur more physicians to work in areas having high numbers of Medicaid patients, such as Rep. Denham’s district in the Central Valley of California.
CMA and SMS executives both thanked Rep. Denham for his efforts to improve health care access in Stanislaus County.
“His dedication to promoting an innovative Medicaid pilot program would increase the physician workforce in the Central Valley, improving access to care for thousands of Stanislaus residents and eventually for patients throughout the Medi-Cal program,” said CMA President Dr. David Aizuss.
SMS President Dr. Lynette Grandison said the society approves of the Medi-Cal pilot project to improve both physician shortages and healthcare access.
“Nearly half of the residents of our county are enrolled in Medi-Cal, and while they have coverage, timely access to physicians has been a long-standing problem,” Grandison said. “We strongly support the twin goals of this important project to increase physician supply by providing incentives for physicians who have completed their medical training in the Central Valley to remain in the area, and to participate in the Medi-Cal program.”
The model for the pilot program follows parameters detailed in the Assessing Critical Care Efforts to Strengthen Services (ACCESS) Act of 2017, H.R. 2779, which Rep. Denham sponsored in June 2017.
H.R. 2779 would establish a Medicaid payment model demonstration project for recruiting and retaining physicians to serve low-income individuals residing in counties in which at least 35 percent of residents are enrolled in Medicaid, according to the summary in the congressional record.
In evaluating this test model under H.R. 2779, the CMMI would be required to assess the model’s applicability to informing national strategies, as well as which Medicaid payment strategies would reduce use of emergency departments and improve access, outcomes and patient satisfaction, according to the summary.
U.S. Reps. David Valadao (R-CA) and Rodney Davis (R-IL) joined Rep. Denham in introducing H.R. 2779 and are among seven Republican cosponsors of the measure.