ACA Provision Drops 65,000 Providers from Medicaid

March 2017~

An Affordable Care Act (ACA) provision which mandates that providers revalidate or recertify their Medicaid reimbursement eligibility has resulted in an estimated 65,000 providers dropped from the program, according to a Modern Healthcare analysis.

The ACA provision was implemented as an effort to curb fraud, waste and abuse in the program and required providers that enrolled in Medicaid prior to March 25, 2011 to send in revalidation notices to the CMS on or before September 25, 2016. Providers who did not comply with the imposed deadlines would be in danger of being dropped from the program.

According to CMS, improper Medicaid payments totaled to $30 billion in 2015 (9.8%). The agency has yet to release its 2016 report on improper payments, but has previously stated it anticipates the rate to hit 11.5% for the year.

The analysis utilized data received from 15 Medicaid agencies and states that while some states were successful in receiving revalidation notices and others are just now evaluating their rolls because of staffing or technical limitations.

In Texas more than 28,000 of its 298,000 Medicaid providers were dropped from the program and 3,226 providers in Indiana were cut, following which many providers left the state, enrolled for a single patient or no longer wished to participate.

Though there has been concern that the large number of providers dropped from the program could inhibit patient access to care, the American Medical Association (AMA) and American Academy of Family Physicians have both stated they have received no reports of access issues in response to the revalidation effort.

Source(s): Modern Healthcare, February 2017; HMA Weekly Roundup, March 2017;