Medicaid Coverage of Acupuncture

Medicaid coverage for Acupuncture is a hotly debated topic among acupuncturists. In Jan 1st 2018 Ohio will be offering Medicaid coverage for its neediest of citizens to get acupuncture. First state to do so in the Midwest. Will this be a good or bad thing? This article attempts to lay out all the information in an effort educate and guide our future legislative efforts in other states.

This article will be divided into 4 segments: A background of what’s going on, the “good” reasons behind medicaid acupuncture coverage, and the “bad” reasons behind acupuncture coverage, the “ugly” political debate that happens when acupuncturists begin to disagree, and finally how to overcome disagreement and move forward.

Also, until the list of professional readers grows, I publish my articles on my clinic website (this website) instead of a different website. However I have a separate EMAIL LIST just for professionals that you can subscribe to. You won’t get updates on my clinic events and other local articles. (Click here to subscribe) I don’t want to go through the trouble of building a new website until there are more subscribers or until I decide (or get approved) to write for an existing journalistic website. So far there is no publication in our profession that is truly objective. So, I’m bootstrapping it.

Background:

The biggest difficulty of discussing this topic is a misunderstanding of what this government program is. Many of us, including me at one point, confused Medicaid with Medicare. Since most acupuncturists aren’t paid by either government program many of us don’t understand what they even are or how they work. We just know they exist.

Medicare is a federal program that provides health coverage if you are 65 or older or have a severe disability, no matter your income. Medicaid is a state and federal program that provides health coverage if you have a very low income.

www.medicareinteractive.org

Therefore Medicaid coverage, and what it covers, is up the the states to decide. Federal government has their finger in it somehow. But that’s not within the scope of this article. Ohio, just opened up Medicaid coverage.

Payouts seem to look like $70 for an initial treatment with $55 for follow-up treatments, seemingly comparable to other states. If you’re in Ohio, and need to know how it works, make sure you join your state association which has numerous benefits including how to navigate these recent changes. (See: OAAOM’s Member Benefits)

The Good:

Over the past 30+ years Acupuncturists have worked extremely diligently to overcome an absurd amount of discrimination by the medical community. Acupuncturists and staticians know empirically that acupuncture works  (see: Evidence Based Acupuncture) yet science has been slowly catching up to understanding how acupuncture has such powerful effects on the body, with so much more yet to be discovered. Additionally acupuncture poses a serious threat to the bottom line of the massively powerful “medical establishment” so this discrimination is further complicated with a obvious war against acupuncture. (see: The Great Acupuncture Conspiracy

The Ohio attorney general sued five big pharma companies (See: USA TODAY Article) following the opioid epidemic we’re facing in America. I write about this problem in my book about drug free approaches to injury recovery (See: Rapid Recovery Resource). Following this lawsuit Ohio then expanded Medicaid to cover acupuncture.

From the perspective of the war against acupuncture (See: War Against Acupuncture) this is a huge win. Not only does it demonstrate government trust in acupuncture it also takes a huge blow against those trying to hurt us. Further, it establishes acupuncturists as the experts of interventions involving the solid filiform needle (See: Stop calling it an Acupuncture Needle) and it could, in theory, help against the fight against “dry needling” which I have an entire chapter of my book dedicated to the subject. (See also: What is Dry needling?)

[Medicaid coverage of acupuncture] means in Massachusetts, that I get to see patients who would never get acupuncture otherwise. I get to treat patients with respect are used to being treated as drug seekers. I get to see patients shift in perspective and come in in disbelief when their pain is significantly diminished and they’re moving better and their headspace is clear. For me, it’s in the healthcare is a right and not a privilege department.

-Amy E. Mager, L.Ac.

I would love to see it covered. I live and practice in rural Eastern Kentucky. I already offer community acupuncture and discounted rates so people can afford to see me. Reimbursement from Medicaid would actually be financially better for me, even if it is minimal.

Wendy Middleton Bentley, L.Ac.

 

I have no idea why [anyone] would be against it. It is covered here in Oregon and it has been a fantastic success to help people get back on their feet. Most people work 40 hours a week, but still live in poverty, hence they qualify for medicaid. Many folks are dealing with chronic pain and end up with rx addictions. Acupuncture has offered not only healing and better quality of life, but I’ve personally helped 6 people end their rx drug addiction. Not to mention all the people on a lot less medication. This is a win win for all of us…. Oregon used to compensate $15-25/treatment. Now they pay the same as BCBS at $62. They pay better than ASHN, CHP and each person has 30 visits per year without a pre-auth. This is the way forward.

-Lisa Pool, L.Ac.

Recap:

  1. A huge win in the war against acupuncture.
  2. It gives credibility to Acupuncture while we still work at overcoming discrimination in the medical community.
  3. It benefits the poor and underprivileged.
  4. It’s compensation is large enough to reimburse a community clinic well.

The Bad:

Medicaid and medicare have become quite the debate in the medical community. Primarily because it puts strains onto private practices. There are many reasons why physicians don’t like Medicaid. (See: Forbes article FYI Forbes publishes quite a bit of unethical anti-acupuncture propaganda on behalf of its big pharma advertisers. Therefore the link provided is a “no-follow” link in that it will not benefit Forbes with an SEO boost. Please remember to do this on your websites whenever providing a link to unfavorable content. Google, “no follow HTML” to get a guide on how to do it on your website.)

I am against it for two reasons.

1. The reimbursement rate is so low that it doesn’t take into account the difficulty of getting paid between all of the rejections and errors and crap that goes along with dealing with Medicaid or any insurance really.

2. I know several doctors on the verge of going out of business because their business has primarily been Medicaid patients and Medicaid has recently started collecting back payments from 3-4 even 5 years ago saying that they were paid in error and now they want the money back with interest. It is a full-time job for them just to fight for the payments in the first place and now they’re having to fight not to give all the money back after the fact.

-JennyMarie Greenough, L.Ac.

 

I have had the experience of the majority of folks I have seen who pay little to nothing for care often are not my best clients as they tend to value the treatments based on what they are paying and often think that the insurance companies are compensating at a high rate and think they are doing me a favor by coming in. People pay for what they value.

Angela Tisci, L.Ac.

 

I am an Ohio acupuncturist, currently in practice in Dayton. I have mixed opinions on this topic. On one side I agree with Amy E. Mager in that it allows some who are not currently able to afford my rates to get acupuncture. On the other side the reimbursement rates are not sufficient to compensate me for my time. The additional time to file and the additional costs incurred to maintain an EMR will not get covered by the payments available. To hire someone to do the work would necessitate me to expand the number of patients I must see. It will reduce the attention that I currently provide. So for my personal choice, at this time, is to not become an OH Medicaid provider. For others it is something to explore.

C Fritz Froehlich, L.Ac.

 

Recap:

  • Medicaid is cumbersome to get reimbursements, the extra paperwork is overtaxing to many private practitioners.
  • There is the risk of Medicaid demanding the reimbursements back back, years later. Potentially shutting down clinics.
  • Reimbursements are too little for the average private practice business model to survive off of.
  • Patient compliance is a problem when they have no perspective of value.

The Ugly:

There is quite a bit of ugly discussion that happens when acupuncturists begin the debate of just about anything, but it’s particularly bad when the subject is political or philosophical. This happens when we lose FOCUS in discussions. Instead of debating XYZ topic it derails to a debate on something else. The following quotes will not be named and are paraphrased so that I am in compliance with the rules of the forums that these quotes were taken from.

I’m an anarchist and believe taxation is theft. Therefore I wouldn’t want to accept money that was stolen from some people for the benefit of others. Medicaid money is stolen.

This quote is actually mine. It’s an extreme opinion and doesn’t belong in this sort of discussion. It’s a matter of philosophy that doesn’t move us forward as a profession.

Our current medical system is in this mess due to the medical/medicaid system that was established in the 60’s through government intervention. Nothing is free – someone always pays the price.

I agree, however we need to focus on our profession, this is a rabbit hole that goes towards division.

There are two issues here: whether or not we are in favor of Medicaid as a entity and whether we think the reimbursement is enough.

That’s right. When we begin a discussion on a topic we often lose sight of what’s important. More important than any opinion or perspective is treating each other with compassion and respect.

How to move forward with conflicting opinions?

So is Medicaid coverage a good thing or a bad thing? The jury is still out. But one thing is certain, as we debate it with each other we MUST remain united. We have to be willing to YIELD to the majority of opinions even if we believe those opinions to be wrong. Otherwise we’ll be gridlocked forever in debate.

What does it mean to yield?  Yielding first means being diplomatic and professional to your colleagues when you disagree with them. Even if they are being stupid, let them save face, don’t just out-right call them stupid.  Letting people “save face” is an important cultural concept lost in the historical studies of TCM.  Second, yielding means still contributing to your association even if they take a position you disagree with.

We do so much work to legitimize our medicine. We still, despite the mounting evidence, fight against discrimination. There is the huge battle against dry needling, and even bigger one in the war against acupuncture. I am against Medicaid as an institution (it should only be for kids) but I am FOR Medicaid coverage for acupuncturists even if the payout is as low as $5.  This is not a matter of hypocrisy it is a matter of advancing the profession in the context of our American medical system, regardless if I believe it to be broken or not.

 

As a stoic I believe, “The impediment to action advances action. What stands in the way becomes the way.”  Even though I disagree with the path we’re taking, it is a path that advances action and makes us more powerful as a profession. I encourage every acupuncturist to, first, treat each other respectfully, and second, join your state acupuncture association that has no conflicts of interest.

-Adrian J Abascal, L.Ac.

Here in Austin Texas there is no Medicaid. So, I take personal responsibility and I offer free treatments to kids with asthma because insurance doesn’t have a drug free option for them. (Know anyone in Austin? Click here to let them know!) It would be nice to be paid, even if it was as little as $5.

If I lived in Ohio this is how I would go about accepting Medicaid:

(I am not an attorney, this is not legal advice. This is solely an example of “how I would do it”.

  1. Open a separate LLC (or PLLC) with a separate phone number and bank account. This LLC essentially becomes a second clinic which shares your office space.
  2. When a patient with Medicaid calls your main clinic, “I’m sorry we can’t accept medicaid because the payouts aren’t enough. But we have a separate practice, called ‘Dayton AcuCare PLLC’, that does accept Medicaid that shares space in our office. Do you want to schedule at the next available appointment?”
  3. Do not advertise the LLC at all. It only will get patients through referral. The general public won’t know this clinic exists, which protects Medicaid patients from the stigma of going to a “poor person clinic” and it masks the clinic from cash payers who don’t have medicaid but want to pay the “medicaid price.”
  4. A single practice cannot accept some cases of medicaid and deny others in favor of cash patients. It’s considered discrimination. But, there is a way to be fair to these folks without discriminating against them. Assign a certain room in your office towards this LLC and write up a sublease agreement for it. (If your office has a limited amount of rooms then lease the room for use by the LLC for certain hours.) This way the lease limits how many Medicaid patients you can see and it will protect your office WHEN something inevitably happens to the Medicaid program.
  5. Dedicate the LLC to medicaid patients but never turn away the rare person who asks for it by name, this way there is no discrimination. Also, if medicaid demands back reimbursements (due to whatever errors they decide to invent) you’re not professionally or personally liable and the LLC can file bankruptcy. Your office can remain open to your main practice.
  6. Medicaid programs can end at any moment and payouts may drop dramatically from year to year. Do not lease out more space in your office to this LLC than you can afford to suddenly lose WHEN the program inevitably changes.