VIRGINIA — Commercial insurers paid more than Virginia Medicaid for the same preventive care services, according to a study published in JAMA Health Forum on September 4, 2026. The research, led by George Mason University professor Alison Cuellar, analyzed payment rates across multiple insurance types using 2023 data from Virginia.

The study compared reimbursement rates for Medicaid fee-for-service, Medicaid managed care, employer-sponsored insurance, Marketplace plans, and Medicare Advantage. Researchers utilized Transparency in Coverage data alongside state claims records to establish the payment differentials for identical medical services.

For the same preventive-care services, the commercial employer-sponsored average rate was 28% higher than the Medicaid managed care rate. Commercial insurance paid 35% more than Medicaid’s fee-for-service program for the same services.

The disparity extended to other coverage types as well. Additionally, Medicaid private managed care plans paid more than 40% less than Marketplace plans for the same services.

Cuellar is a professor of health administration and associate dean of research for the College of Public Health at George Mason University. Meredith Young of the Virginia Center for Health Innovation and Jennifer Mellor of William & Mary conducted the research with her. The Robert Wood Johnson Foundation's Health Data for Action program supported the work.

"The fear is exactly that if the doctors aren’t getting close to the same amount of money, at least, that they would for a commercially-insured individual, that the doctors won’t see patients who have Medicaid coverage," Cuellar said. The study focused on reimbursement rates and did not directly examine physician participation or patient access.

What's New

Additional details from the research team clarify the specific financial gaps identified in the analysis. Medicaid managed care plans paid a median rate of $96.22 for a routine preventive visit for an established patient ages 40 to 64, while Virginia’s traditional Medicaid fee-for-service program paid a median rate of $90.86 for the same service.

Beyond the immediate findings on preventive care payments, broader policy changes are affecting the Medicaid population in Virginia. More than 500,000 of Virginia’s nearly 2 million Medicaid enrollees will be subject to new work requirements and additional verification paperwork each year under the reconciliation bill.

State officials have acknowledged the fiscal pressures involved in maintaining current support levels. "We did the best we could with the budget. But trying to sustain that for years and years would be tough," Delegate Rodney Willet said.

Why It Matters

The gap in reimbursement rates between commercial insurers and Medicaid programs affects provider participation in the public system. When physicians receive substantially lower payments for treating Medicaid patients compared to those with private insurance, the financial incentive to accept public coverage diminishes. This dynamic can limit access to preventive care for low-income residents who rely on Medicaid for their health services.

These payment disparities occur alongside other structural changes to Virginia's health safety net. While state lawmakers earmarked funds to assist individuals between 138% and 250% of the federal poverty level, concurrent policies such as new work requirements and coverage restrictions for lawful immigrants alter the landscape for enrollees. The combination of lower provider payments and increased administrative burdens for patients creates a complex environment for maintaining consistent healthcare access across the state.