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High Provider Participation Rates in Medicaid Pre-Implementation

• For most states, primary care provider participation was generally viewed as high preceding the policy.
• Providers who decline to participate in the Medicaid program tend to do so because of low reimbursement rates, administrative difficulties, and challenges associated with caring for Medicaid patients.

Implementation Complicated by Limited Time Line

• States did not receive final guidance until two months before the policy was supposed to begin and additional clarification was required subsequently. This delayed states' ability to provide attestation guidance to providers, which, in turn, delayed states' and MCOs' efforts to configure claims-processing systems and initiate payments.

Implementation Challenges Posed by Provider Eligibility Criteria and Attestation Processes

• A large number of physicians who met the eligibility criteria viewed themselves as specialists rather than primary care physicians.
• Several respondents suggested that the eligibility criteria failed to reflect the way primary care was delivered in many states — particularly by excluding advanced practice nurses.

No Formal Evaluations Conducted by State-Level Stakeholders; Perception of Limited Impact

• Most respondents indicated that the policy had, at best, a modest impact on incentivizing higher rates of provider participation.
• Respondents in most states noted that increased payments over a span of only two years did not provide a potent incentive for physicians to make investments needed to expand their participation in Medicaid.

Patients and Providers Realized Benefits

• Most respondents suggested that the program was beneficial and helped keep Medicaid providers "afloat" for the duration of the policy.