ANA Factsheet on Medicaid Reimbursement


  • Current laws regarding Medicaid reimbursement for nurse practitioners and clinical nurse specialists are extremely complicated in terms of which categories of these advanced practice registered nurses may be reimbursed. In fact, these laws are so confusing for carriers, providers and consumers that they have become a barrier to access to health care services in and of themselves.
  • Under current law, state Medicaid programs are required to provide direct reimbursement to pediatric nurse practitioners, family nurse practitioners and certified nurse midwives. Some states have opted to cover the services of other advanced practice registered nurses, while other states have chosen not to include services of advanced practice registered nurses beyond the current Federal mandate. Although states set their own reimbursement rates for Medicaid providers, payment levels must be adequate to ensure that Medicaid beneficiaries have access to services comparable to those enjoyed by the general population.
  • Millions of Americans each year go without the health care services they need because physicians simply are not available to care for them. This problem plagues rural and urban areas alike. Medicaid beneficiaries are particularly vulnerable, since in recent years an increasing number of health professionals have chosen not to care for them or have been unwilling to locate in the inner-city and rural communities where many of the beneficiaries live. Nurse practitioners and clinical nurse specialists are an exception to this trend; they frequently accept patients whom others will not treat and serve in areas where others refuse to work.
  • Legislation has been introduced in both the House of Representatives and the Senate to provide Medicaid reimbursement to all nurse practitioners and clinical nurse specialists. These bills recognize that better utilization of nurse practitioners and clinical nurse specialists will help to increase access to quality care for the country’s unserved and underserved populations. In addition, these bills will help to decrease acute care admissions and the misuse of emergency rooms. It is time for the Medicaid program to fully recognize the quality of care and cost-effectiveness of the health care services provided by nurse practitioners and clinical nurse specialists.
  • H.R. 1514, to provide Medicaid reimbursement to all nurse practitioners and clinical nurse specialists, was introduced in the House of Representatives on April 21, 1999 by Rep. John Olver (D-MA) and has been referred to the Commerce Committee. A companion measure S. 863, was introduced in the Senate on April 22, 1999 by Senate Minority Leader Tom Daschle (D-SD) and has been referred to the Finance Committee.
  • As of June 1, 1999, the following members of the House of Representatives have joined Rep. Olver as cosponsors of H.R. 1514: Reps. David Bonior (D-MI), Rick Boucher (D-VA), James Clyburn (D-SC), Lane Evans (D-IL), Barney Frank (D-MA), Martin Frost (D-TX), Maurice Hinchey (D-NY), Nancy Johnson (R-CT), Ron Kind (D-WI), Steve LaTourette (R-OH), James McGovern (D-MA), Bob Ney (R-OH), Nick Rahall (D-WV), Lynn Rivers (D-MI), Bernard Sanders (I-VT), Jose Serrano (D-NY), Ronnie Shows (D-MS), Debbie Stabenow (D-MI), Ted Strickland (D-OH) and Bart Stupak (D-MI)
  • As of May 20,1999, the following members of the Senate have joined Sen. Daschle as cosponsors of S. 863: Sens. Barbara Boxer (D-CA), Bryon Dorgan (D-ND) and Daniel Inouye (D-HI)

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