CMS has proposed capping certain state Medicaid payments by more than $775 billion over 10 years, including $510 billion in federal savings. The proposal is drawing criticism from hospital groups, and spine surgeons are also concerned about its affects on patients.
Spine surgeons discuss what this move could mean for the specialty and patient access.
Question: If Medicaid reimbursements are capped closer to Medicare rates, how would that affect your willingness or ability to accept Medicaid patients? What does that mean for your Medicaid patient volume?
Kasra Ahmadinia, MD. Advanced Orthopedics of Oklahoma (Tulsa): Proposed Medicaid cuts and efforts to cap reimbursement closer to Medicare rates would likely put additional financial pressure on spine practices, particularly for complex surgical care. While Oklahoma’s baseline Medicaid rates are already near Medicare in some cases, much of the real support comes from supplemental and directed payments, and those are the areas most at risk. For spine surgeons, where procedures carry higher costs and patients often have greater medical complexity, even small reimbursement reductions can quickly make cases financially unsustainable. As a result, we may see reduced access to elective spine care for Medicaid patients, longer wait times, and increasing pressure to shift appropriate cases to outpatient or ASC settings. Ultimately, these changes could widen the gap in access to specialized spine care for vulnerable patient populations.
Brandon Ortega, MD. Long Beach (Calif.) Lakewood Orthopaedic Institute: At this time, I do not participate in Medicaid, and the proposed reimbursement structure is a significant part of why. When you examine what Medicare already pays for complex spinal surgery, accounting for OR time, implant costs, post-operative care, and prior authorization overhead, the reimbursement already falls short of the true cost of care. Capping Medicaid closer to those rates doesn’t make the math work; it makes participation less viable for independent specialty practices. The broader issue is that these cuts will further narrow the specialist network available to Medicaid patients. Reimbursement drives participation, and when rates don’t support the cost of delivering high-quality specialty care, physicians, particularly those in private practice without institutional subsidies, simply can’t absorb it. The patients who need subspecialty care most are the ones who will feel that gap.
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