YOUR Feedback on ways to Reduce Low-Value Care in Medicaid and Improve Efficiency

Two weeks ago, Medicaid providers were notified of a potential rate cut stemming from conflicting views on the Medicaid rebase number between the General Assembly’s non-partisan Fiscal Research Division and the Governor’s Office. The Department of Health and Human Services, alongside House Leadership and staff, continues to engage in discussions to reconcile the differing rebase figures. A House package, anticipated in the coming weeks, is expected to address the rebase issue without implementing provider rate cuts. We requested physicians and PAs provide us with ideas regarding possible improvements in Medicaid that may obviate the scheduled cuts.

Thank you to everyone who shared feedback on ways to reduce low-value care in Medicaid and improve efficiency. Here are the main themes from your responses:

1. Low-Value or Unnecessary Services

  • Overuse of tests or screenings outside guidelines (e.g., Pap smears after hysterectomy, imaging for minor complaints).
  • Concerns about fraud/overuse with durable medical equipment (DME) and telehealth.
  • Emergency department visits for minor issues instead of primary/urgent care.
  • Redundant services when patients switch between providers or systems.

2. Administrative & System Inefficiencies

  • Excessive paperwork and administrative burden on physicians and staff.

3. Suggestions for Improving Efficiency

  • Improve patient education and accountability (keeping appointments, preventive care awareness).
  • Invest in prevention, wellness programs, and education to reduce avoidable utilization.
  • Allow flexibility in site of service to lower costs (outpatient vs. hospital).
  • Ensure coverage for essential, high-value care at true cost (e.g., corneal tissue).

4. Impact of Rate Cuts

  • Many respondents said cuts will make it unsustainable to care for Medicaid patients, especially rural, pediatric, and solo practices already operating at break-even.
  • Broader concerns included: increased reliance on costly emergency departments, consolidation of practices into larger systems, and challenges for safety-net clinics with limited funding.
  • While Medicaid expansion was seen as positive, many warned that cuts could compromise those gains.

Your feedback underscores both the urgency and complexity of these issues. We will continue using these insights to guide our advocacy and ensure physicians and patients are supported. If you have not had a chance to respond, please do so here.