NCART to Medicaid: ‘We can’t continue down this road’

WASHINGTON – NCART has officially put state Medicaid programs on notice that they should be following Medicare’s lead in implementing a reimbursement increase for complex rehab products and services. 

NCART in June sent letters to state Medicaid programs, asking them to increase their reimbursement and to work with the organization and other stakeholders to develop policies that best serve people with disabilities. 

“We’re putting a lot of focus on reimbursement relief, especially on the state level,” said Wayne Grau, executive director of NCART. “They need to step up and raise the reimbursement rate – at the bare minimum for cost of living and high inflation.” 

CMS in January implemented an 8.7% increase for complex rehab and up to a 9.1% increase for repairs and replacement parts, as part of its CPI-U adjustments. 

But many state Medicaid programs have not increased their reimbursement, according to NCART. 

“There are some states that base their reimbursement right off of the Medicare fee schedule, so when they make their adjustments on a quarterly or yearly basis, they’ve incorporated that increase,” said Mickae Lee, assistant director of NCART, “but we’re reaching out to the states that have not.” 

One of those states: California. The state Medicaid program there, called Medi-Cal, hasn’t increased reimbursement for complex rehab since 2007, according to NCART. There are more than 15 codes where reimbursement in the state is 23% to 79% below Medicare’s, the organization says. 

“You meet with Medicaid officials there, and they say they’re not allowed to implement an increase, but then you meet with state lawmakers, and they say Medicaid can do it,” Grau said. “They’re pointing fingers at each other, when our providers are facing having to make some potentially bad decisions, like reducing their service area, which will impact access.” 

In an environment where labor costs, alone, are up 132% in California since 2008, the decision not to increase reimbursement makes no sense, NCART says. 

“Labor is through the roof, and then you have the fact that we’re already not getting paid for the traveling, the evaluating, the diagnosing for repairs,” Grau said. “It’s an untenable situation. We can’t continue down this road.”