A new study by the Office of Inspector General for the Department of Health and Human Services found half of all providers listed in Medicaid managed care plan are not available to new Medicaid patients, either because they are not at the listed location or they are but aren’t accepting new Medicaid patients.
For doctors who are accepting new Medicaid patients, the average wait to get an appointment is two weeks, with a quarter of patients having waits of one month or longer.
The study’s findings come as enrollment in Medicaid continues to grow, largely from the expansion in eligibility through the Affordable Care Act and also as a result of a lackluster economy.
Devon Herrick, a senior fellow and health care researcher for the National Center for Policy Analysis, says the fees state Medicaid programs pay are often only about half of what private insurers pay for the same service. As a result, doctors are reluctant to participate in Medicaid managed care plans.
“Many physicians limit the number of new Medicaid patients they treat to a ratio of privately insured patients they treat,” Herrick said. “That is one reason expanding Medicaid will not necessarily boost access to care: many new Medicaid enrollees cannot find doctors who will treat them for the paltry fees Medicaid pays them.”
The Office of Inspector General (OIG) investigators called 1,800 providers listed in Medicaid managed care plans to assess availability and the time it took to get an appointment for enrollees. Physicians called included cardiologists, family practice doctors, obstetricians, orthopedists, pediatricians, and urologists, and covered both urban and rural areas.
About 35 percent of providers were not at the location listed by the Medicaid plan. According to the OIG report, “Callers were sometimes told that the practice had never heard of the provider or that the provider had practiced at the location in the past but had retired or left the practice.”
Another 8 percent of providers listed by Medicaid managed care plans either are not participating in that plan or did participate but aren’t accepting new Medicaid patients.
The study also found primary care providers are harder to get an appointment with than specialists, but the wait times for specialists are typically longer.
Enrollment, But Not Access
Expansion of Medicaid was one of the key components of the Affordable Care Act, leading to the enrollment of an additional 10 million Americans in the program in 2014, many of whom will be in managed care plans.
But increased enrollment may not translate into increased access to care for many Medicaid participants, according to OIG.
“Without adequate access, enrollees cannot receive the preventive care and treatment necessary to achieve positive health outcomes and improved quality of life,” the report concluded. It also noted, “Long wait times can have a significant impact on patient care.… That so many providers could not offer appointments within a month raises concerns about enrollees’ ability to obtain timely access to care.”
Further Reimbursement Cuts
Many state Medicaid programs are making deep cuts in payments to primary care doctors as additional funding that boosted fees paid to them, made available under the Affordable Care Act, ran out on December 31, 2014.
A study by the Urban Institute estimates doctors who have been receiving the enhanced payments will have their fees for primary care cut by 43 percent, on average.
“Physicians cannot pay their office overhead and expenses with this poor reimbursement,” said Dr. Roger Stark, a health care policy analyst at the Washington Policy Center and a retired physician. “Consequently, our existing Medicaid patients have an increasingly difficult time accessing care.
Stark said Medicaid reimburses doctors on average 40 percent of what private insurance pays. “The expansion of Medicaid through the ACA will only make this access problem worse,” Stark said.
Dr. John Dale Dunn, an emergency physician and policy advisor to The Heartland Institute, says reducing payments necessarily reduces access.
“Medicaid is the most notoriously low-paying program,” Dunn said. “In fact, there are very few physicians who like taking care of Medicaid patients, since it’s an indigent care plan and offers the lowest form of payment.”
Kenneth Artz ([email protected]) is a freelance writer for The Heartland Institute.
Internet info: Access to Care: Provider Availability in Medicaid Managed Care, Office of the Inspector General, 2014. http://heartland.org/policy-documents/access-care-provider-availability-medicaid-managed-care