Medicaid insures more than 70.5 million Americans, according to the most recent report from the Centers for Medicare and Medicaid Services. Largely low-income health care consumers, these patients have had a notoriously difficult time finding physicians to treat them, and in a reasonable amount of time.
With an influx of people qualifying for the public insurance and changes to providers’ reimbursement rates, it’s difficult to say if these troubles will improve or worsen. So it’s crucial that Medicaid beneficiaries know what they’re up against.
In an effort to make it easier for Medicaid patients to see the doctor, the federal government increased Medicaid reimbursement fees in 2013 as part of the Affordable Care Act. When 2014 came to a close, so did that program, and fees once again fell in many states — though some states chose to continue paying higher rates on their own.
It’s too early to say with certainty how the fee changes — both the rise and subsequent fall — have affected patients, but even prior to the fee bump and before the ACA expanded Medicaid to include millions more Americans, these patients sometimes struggled to get in to see the doctor, had worse health outcomes and found themselves holding a good insurance policy with nowhere to use it.
“There are certain aspects of Medicaid, particularly for low-income populations, where it is really almost superior to private [insurance] coverage, with very low copays and no deductibles,” says Stephen Zuckerman, co-director and senior fellow with the Urban Institute’s Health Policy Center. “But at the same time, Medicaid beneficiaries are significantly more likely to report having difficulty finding a provider or delaying care because their health care coverage isn’t widely accepted.”
A 2011 nationwide survey of doctors found 31 percent were “unwilling” to accept new Medicaid patients, with acceptance rates across states varying widely. Across the nation, the study estimated 69 percent of doctors were accepting Medicaid, but state acceptance rates ranged from a low of 40 percent in New Jersey to 99 percent in Wyoming, according to the study published in Health Affairs. This was pre-ACA expansion and prior to any reimbursement fee changes.
Why Some Doctors Won’t Accept Medicaid
When comparing reimbursement rates among health insurance plans, Medicaid is the lowest payer, meaning it’s not a moneymaker for doctors’ offices. Paired with the administrative requirements of accepting public insurance, doctors sometimes just don’t want the hassle.
The fee bump of 2013 to 2014 sought to make Medicaid acceptance more enticing by putting those fees on par with Medicare reimbursement rates.
“We don’t know if physician participation in the Medicaid program really increased as a result of the fee increases,” Zuckerman says. But a study he worked on with colleagues from Urban Institute and the University of Pennsylvania did find one way the fee bump helped.
Evaluating wait times for appointments in two periods — November 2012 through March 2013, and May 2014 through July 2014 — the study, published in the New England Journal of Medicine, reported Medicaid patients found it easier to make appointments after the fee bump, and those states with the biggest changes in wait time were those with the largest increases in reimbursement rates.
It’s this study that may have motivated some states to continue reimbursing doctors at higher rates after the federal bump expired on Dec. 31, 2014. According to the University of Pennsylvania, 16 states have elected to continue paying at least partially higher rates than they had pre-bump, to continue encouraging doctor participation in the Medicaid program. In the other states, fees have dropped.
Given that states have wildly different acceptance rates, different reimbursement rates and various state-set nuances, the effects of all this remain to be seen. But it stands to reason that beneficiaries may struggle again for their appointment times.
“You would think if there were access problems that the fee bump dealt with for a couple of years, that those access problems could reemerge,” says Zuckerman, who reiterates the lack of data backing this hypothesis. On the other hand, Zuckerman says, doctors knew the fee adjustment wasn’t permanent, and those who increased their participation may not make major adjustments in light of any changes.
What Does It Mean For You?
If you’re on Medicaid, this may be more than you care to know. The bottom line: You need a doctor, and you shouldn’t have to wait an unreasonable amount of time for an appointment. How you navigate your state’s Medicaid system likely hasn’t changed, but finding a doctor may require some legwork.
If you had a doctor prior to receiving Medicaid approval, call the office to discuss staying on as a patient. If the doctor accepts Medicaid, you likely won’t have to look for a new provider.
If you need a doctor, check your state’s Medicaid website for a provider directory. If your state doesn’t offer one, contact the doctor you’re interested in and ask if he or she is accepting new Medicaid patients. Ask what the average wait time is for a new patient appointment, and use that answer to compare a few different providers in your area. You can also use tools such as the Medicare.gov Physician Compare, Healthgrades or the U.S. News Doctor Finder to see how doctors stack up.
If you live in a state where Medicaid doctors are in short supply, you may find using a health center or community clinic is your best option. And before you turn up your nose, know that the ACA-funded major improvements and the expansion of health centers across the country in part to help deal with the influx of new Medicaid patients. Further, a Kaiser Family Foundation study found these centers to largely be on par (or even better) than other Medicaid managed care organizations in terms of quality, even before the ACA-funded improvements.
It is possible to get high-quality medical care under the Medicaid system. Navigating your way through the system, however, can be difficult. Regardless of how doctors are getting reimbursed or who is accepting the public insurance, your health should remain a top priority. So don’t delay medical care out of frustration, and remember to stay flexible with your provider choices.
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You’ve Got Medicaid — Why Can’t You See the Doctor? originally appeared on usnews.com
