Report: Pennsylvania Medicaid Physician Payment Analysis

Introduction

On behalf of the Hospital and Healthsystem Association of Pennsylvania (HAP), Health Management Associates, Inc. (HMA), conducted a survey of HAP member hospitals and health systems to analyze costs for their employed and contracted physician services provided to Medicaid and uninsured populations and determine to what extent reimbursement covered the costs of those services. Combining these results with a similar analysis on hospital services offers a comprehensive look at the financial burden hospitals and health systems bear when providing care to Pennsylvania’s Medicaid and uninsured patients. Results from the survey indicate that physician services are reimbursed at only about 40 cents on the dollar for these populations. Along with the payment-to-cost shortfall on the hospital side, this figure indicates that over $4.2 billion in annual costs are unrecouped.

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Topics: Access to Care, Federal Advocacy, Medicaid, State Advocacy, Workforce

Revision Date: 9/30/2025

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