November 9, 2006 |
2006-R-0693 | |
IMPACT OF ELIMINATING MEDICAID COVERAGE FOR INDEPENDENT PRACTITIONER PODIATRISTS | ||
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By: Robin K. Cohen, Principal Analyst | ||
You asked whether the Department of Social Services (DSS) had saved any money by eliminating Medicaid coverage for podiatrists in 2002.
SUMMARY
According to DSS, it does not appear that the state saved any money by eliminating Medicaid coverage for podiatrists in 2002, despite having factored savings into the FY 03 budget. Rather, the costs for these services have shifted from podiatrists to other medical providers.
IMPACT OF ELIMINATING MEDICAID COVERAGE FOR PODIATRISTS
PA 02-7, May 9 Special Session (§104), required DSS to submit an amendment to its Medicaid State Plan to implement provisions in the FY 03 budget act concerning “optional” services. (Optional services are those services that federal law allows states to provide under Medicaid versus services that are mandatory, such as emergency care. ) Although the act did not explicitly require this, DSS interpreted it as a mandate to eliminate Medicaid payment to the following independently enrolled providers: podiatrists, chiropractors, naturopaths, “independent therapists” (physical therapists, licensed audiologists, and speech pathologists), and psychologists for any services they provided to Medicaid recipients aged 21 and older. (This coverage was also eliminated from the then-General Assistance and State-Administered General Assistance programs. )
The change took effect January 1, 2003.
According to a DSS analysis of payments for podiatry services six months before and after the change occurred, Medicaid podiatry costs did not fall significantly. (DSS used the six-month period because it does not have data for any earlier period than six months before coverage was eliminated. ) Rather, most costs were shifted from podiatrists to a category of providers called “Other MD,” while a small percentage shifted to orthopedists.
Table 1 illustrates what occurred.
Table 1: Podiatry Services With Dates of Service in FY 03 [1]
July-December |
Jan-June | ||
Physician/Group |
Orthopedics |
$ 56,789. 15 |
$ 71,133. 03 |
Physician/Group |
Other MD |
498,574. 19 |
946,420. 82 |
Podiatrist/Group |
Podiatrist |
577,360. 11 |
45,595. 88 |
Source: DSS (November 2006)
[1] The data does not include podiatry services received in clinics or outpatient hospital settings. DSS pays an inclusive rate to these providers, and there is no way to break out podiatry costs. But one can assume that more people received podiatry services in these settings after the policy changed.
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