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Special Report
by Edward B. Feehan, MD
| Payment Ratio for Medicaid (1998) – State rate for Medicaid (not managed care) divided by rate paid in California (not managed care) for a 99213 |
| Alabama | Alaska | Arizona | Arkansas | California | Colorado | Connecticut | Delaware | District of Columbia | Florida | Georgia | Guam | Hawaii | Idaho | Illinois | Indiana | Iowa | Kansas | Kentucky Louisiana | Maine | Maryland | Massachusetts | Michigan | Minnesota | Mississippi | Missouri | Montana | Nebraska | Nevada | New Hampshire | New Jersey | New Mexico | New York | North Carolina | North Dakota | Ohio | Oklahoma | Oregon | Pennsylvania | Rhode Island | Samoa | South Carolina | South Dakota | Tennessee | Texas | Utah | Vermont | Virginia | Washington | West Virginia | Wisconsin | Wyoming | |
| States | Payment |
Ratio to CA |
Comments | 1998 Federal Cost Share for the State | State Share of 99213 in Dollars |
| Alabama | $31.00 |
1.87 |
Well child checkup is paid at $70.00 | 69.32% | $9.51 |
| Alaska | $53.52 |
3.23 |
Soon going to 62.92 by reason of RVRBS update, ENT and Orthopedist complain the 53.52 is so low. State has 85% participation of all physicians. Some dentists practice on yachts and deduct the yacht. No managed care in the state. | 59.80% | $21.51 |
| Arizona | $36.28 | 2.19 | . | 65.33% | $12.58 |
| Arkansas | $33.00 | 1.99 | . | 72.84% | $8.96 |
| California | $16.56 |
1.00 |
Community clinics are paid 24% higher, other clinics five percent greater than private physicians. | 51.23% | $8.08 |
| Colorado | $31.50 |
1.90 |
.
|
51.97% | $15.13 |
| Connecticut | $19.50 |
1.18 |
. | 50% | $9.75 |
| Delaware | $37.09 |
2.24 |
$35.41 until recently. | 50% | $18.55 |
| District of Columbia | $18.00 |
1.08 |
Data was received by phone and fax. DC rate was $20.00 from 12/1/82 - 7/1/98 and then will be updated. | 70% | $5.40 |
| Florida | $25.00
|
1.51 |
Mean payment for RHC is 55.50, for FQHC is 89.06 and Medicaid in a health dept. is paid on cost basis with mean of 72.18. | 55.65% | $11.09 |
| Georgia | $30.29 |
1.83 |
. | 60.84% | $11.86 |
| Guam | $32.00 |
1.93 |
. | 50% | $16.00 |
| Hawaii | $23.04 |
1.39 |
Hawaii pays persons who are Medicaid providers less than one year $18.43 and was one of the few states who seemed aware that their payment under Medicaid is 20-25% of what a FQHC might get. | 50% | $11.52 |
| Idaho | $33.26 |
2.01 |
Effective date clarified as 7/1/97 not 7/1/98 | 69.59% | $10.11 |
| Illinois | $18.55 |
1.12 |
This ratio is for care delivered outside of HMOs. HMO rates are not tracked by the state. | 50% | $9.28 |
| Indiana | $25.98 |
1.57 |
. | 61.41% | $10.03 |
| Iowa | $30.49 |
1.84 |
. | 63.75% | $11.05 |
| Kansas | $17.00 |
1.03 |
Pays less for adults over 21. This is the adult rate | 59.71% | $6.85 |
| Kansas | $27.00 |
1.63 |
Pays more for children under 21. This is the children rate. | 59.71% | $10.88 |
| Kentucky | $27.06 |
1.63 |
. | 70.37% | $8.02 |
| Louisiana | $24.30 |
1.46 |
. | 70.03% | $7.28 |
| Maine | $28.94 |
1.75 |
Follow up letter sent Response from original letter received one day after follow up letter sent |
66.04% | $9.83 |
| Maryland | $31.00 |
1.87 |
Follow-up letter sent 7/30/98 | 50% | $15.50 |
| Massachusetts | $33.54 |
2.03 |
. | 50% | $16.77 |
| Michigan | $21.00 |
1.27 |
. | 53.58% | $9.75 |
| Minnesota | $24.00 |
1.45 |
Many of the Medicaid patients are in managed care and those rates were not supplied. | 52.14% | $11.49 |
| Mississippi | $20.16 |
1.22 |
Site differential of $16.46 | 77.09% | $4.62 |
| Missouri | $24.00 |
1.45 |
This rate applies to patients over age 21. Updated 7/1/98. | 60.68% | $9.44 |
| Missouri | $31.00 |
1.87 |
This rate applies to patients under 21. Updated 7/1/98 | 60.68% | $12.19 |
| Montana | $32.75 |
1.98 |
. | 70.56% | $9.64 |
| Nebraska | $31.05 |
1.88 |
. | 61.17% | $12.06 |
| Nevada | $34.06 |
2.06 |
Follow up letter sent and response received 5/21/98 | 50% | $17.03 |
| New Hampshire | $27.00 |
1.63 |
Follow up letter written | 50% | $13.50 |
| New Jersey | $14.00 |
0.85 |
Payment is 16.00 when provided by specialist.
Prices in effect twelve years and this state has mostly transitioned to managed care. Follow up request sent on 5/21/98 |
50% | $7.00 |
| New Mexico | $31.16 |
1.88 |
. | 72.61% | $8.53 |
| New York | $33.00 |
1.99 |
Requires Board Certification or Bd Elig limited to 5 years, must have hospital privileges, payment is 11.00 for those not in the preferred provider group. | 50% | $16.50 |
| North Carolina | $32.30 |
1.95 |
. | 63.09% | $11.92 |
| North Dakota | $32.70 |
1.97 |
. | 70.43% | $9.67 |
| Ohio | $27.48 |
1.66 |
. | 58.14% | $11.50 |
| Oklahoma | $20.91 |
1.26 |
Only state to fax the data | 70.51% | $6.17 |
| Oregon | $23.75 |
1.43 |
. | 61.46% | $9.15 |
| Pennsylvania | $20.00 |
1.21 |
. | 53.39% | $9.32 |
| Rhode Island | $20.64 |
1.25 |
. |
53.17% | $9.67 |
| Samoa | NA | NA | 100 % of the population qualifies for Medicaid without having to apply and the funds are administered directly by the Samoan government. | 50% | $0.00 |
| South Carolina | $21.50 | 1.30 | . | 70.23% | $6.40 |
| South Dakota | $28.70 | 1.73 | Follow up letter sent 5/13/98 response received 6/4/98 | 67.75% | $9.26 |
| Tennessee* | . | . | . | 63.36% | $0.00 |
| Texas | $26.87 |
1.62 |
62.28% | $10.14 | |
| Utah | $25.34 |
1.53 |
Rural Medicaid is paid at 12% higher than non-rural. Urban is the four counties from Ogden to Provo. Every other county gets the 12% increase. | 72.58% | $6.95 |
| Vermont | $25.80 |
1.56 |
. | 62.18% | $9.76 |
| Virginia | $30.54 |
1.84 |
. | 51.49% | $14.81 |
| Washington | $26.35 |
1.59 |
If patient is over age 20. This is the over age 20 rate. | 52.15% | $12.61 |
| Washington | $43.22 |
2.61 |
If patient is under 20 years of age. This is the under age 20 rate. | 52.15% | $20.68 |
| West Virginia | $31.19 |
1.88 |
. | 73.67% | $8.21 |
| Wisconsin | $27.38 |
1.65 |
Payment for 99213 for non-primary care is $26.57. | 58.84% | $11.27 |
| Wyoming | $28.80 | 1.74 | . | 63.02% | $10.65 |
| *Tennessee has no data in the table because they report that they have no remaining fee for service Medicaid. | |||||
Created 7/15/98 Last Updated August 10, 2004