107th Congress

Medicaid Coverage of Advanced Practice Nursing

Message to Congress Medicaid should cover all services that nurse practitioners and clinical nurse specialists are legally authorized to perform under state law. ANA supports and advocates for this expansion of the Medicaid program in order to increase health care access to under served populations, including those who receive health care services through Medicaid managed care entities.

The Issues Surrounding Medicaid Coverage for APRNs:

• Advanced practice registered nurses (APRNs) are registered nurses (RNs) who have attained advanced expertise in the clinical management of health problems. Typically, an APRN holds a master's degree with advanced didactic and clinical preparation beyond that of the RN. Most APRNs have extensive practice experience as RNs prior to entering graduate school. APRNs provide health care for individuals across the life span. Practice areas include, but are not limited to, family, gerontology, pediatrics, women's and adult health, neonatology, mental health, and anesthesiology.

• Prior to 1997, federal law required state Medicaid programs to cover health care services provided by some APRNs (pediatric nurse practitioners, family nurse practitioners, and certified nurse midwives). Some states opted to also cover the services of certified registered nurse anesthetists and clinical nurse specialists. However, with the passage of the Balanced Budget Act of 1997 (BBA) (P.L.105-33) the federal mandate was effectively removed. The BBA encouraged states to move Medicaid beneficiaries into managed care programs, using a primary case manager as the gatekeeper for services. The BBA allows states the option to (or not to) recognize APRNs as primary case managers. In states where only physicians are recognized as primary case managers, APRN services are not available to many Medicaid beneficiaries. Interestingly, the BBA also expanded access to APRN services for Medicare beneficiaries, in fee-for-service Medicaid, by removing a previous geographic limitation on direct access to APRNs.

• ANA supports and will continue to advocate for the introduction of federal legislation to ensure that Medicaid beneficiaries can have access to the full range of services provided by APRNs, including case management services. 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 and to 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, passage of this legislation will help to decrease acute care admissions and the misuse of emergency rooms.

• Each year millions of Americans go without the health care services that they require 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 a number of health professionals have chosen not to care for them or have been unwilling to locate to the communities where many beneficiaries live. APRNs are an exception to this trend; they frequently accept patients that others will not treat and serve in provider shortage areas.

Return to U.S. Federal Affairs.

Search	Contact ANA	Join/Renew Membership	Members Only	Online CE
NursingInsiderSpecial Offersnursesbooks.org © 2008 The American Nurses Association, Inc. All Rights Reserved Copyright Policy | Privacy Statement