Friday, February 27, 2015
February 26, 2015
Medicaid Acceptance by Healthcare Providers Drops to 1-out-of-3
By Kev Coleman
When HealthPocket first investigated Medicaid acceptance in 2013, it
found that only 43% of the healthcare providers examined were formally
listed as accepting Medicaid. Since the original 2013 study, Medicaid
enrollment has continued to rise as the Affordable Care Act has led many
states to increase the income eligibility range for the program.
Medicaid, along with the Child Health Insurance Program (CHIP),
currently covers approximately 1-in-5 people in the United States. This
year, the temporary increase in Medicaid payments to primary care
physicians discontinues with only 15 states indicating that they intend
to maintain the payment increase (fully or partially). The reduction in
Medicaid reimbursement to primary care physicians has brought with it a
concern that Medicaid acceptance, already low among healthcare
providers, will drop further.
HealthPocket found that in 2015 only 34% of the healthcare providers
examined were listed as accepting Medicaid insurance. This represents a
21% decrease from the listings of Medicaid acceptance found in the 2013
data for the same categories of healthcare providers.
Since both the 2013 analysis and 2015 analysis relied upon the same
government data source and provider record parameters, the marked
decline in Medicaid acceptance is significant. In particular, the data
calls into question whether the temporary increase in Medicaid payments
to primary care physicians effected any lasting improvements to Medicaid
Why Do Some Healthcare Providers Avoid Medicaid?
A common explanation given for Medicaid lower acceptance is the
program's reimbursement rate to healthcare providers. Medicaid typically
pays 61% of what Medicare pays for the same outpatient physician
services. To make matters worse, the Medicare payment benchmark is
already lower than payments for the same services from private insurers.
It is estimated that Medicare typically pays 80% of what commercial
health insurers pay. Consequently, in comparison to commercial health
insurance from private insurance companies, Medicaid payments represent
a reduction on a reduction.
One of state governments' responses to the problem is the use of managed
care organizations to serve some portion of a state's Medicaid
population. However, as a 2014 Health & Human Services study noted,
state standards regarding the ratio of primary care physicians to
Medicaid managed care enrollees can vary widely (1-to-100 to 1-to-2,500)
as do their methods for determining compliance with these standards.
Consequently, Medicaid enrollees can face the prospect of long distances
and/or long waits to access care under the program.
From the Conclusion
HealthPocket's comparison of Medicaid acceptance listings from 2013 to
2015 illuminates an alarming trend for those dependent on Medicaid for
their healthcare: a reduction in Medicaid acceptance occurring during a
period of Medicaid enrollee expansion. How federal and state governments
will reverse this trend remains to be seen. The temporary increase in
Medicaid payments to primary care physicians from 2013 to 2014 does not
appear to have produced a lasting increase in Medicaid acceptance and
the expiration of this increase may contribute to further healthcare
provider attrition from the Medicaid program.
Guest Comment by Richard Gottfried, Chair, Committee on Health, New York
State Assembly, and sponsor of A05062 (S03525), "The New York Health Act":
"If the Medicaid recipient's doctor were paid the same as my doctor,
this wouldn't be a problem. And if we were all in the same health plan,
the wealthy and well-connected would see to it that their doctors were
paid fairly, and the rest of us (and our doctors) would share the
benefit. If we're all in the same boat, we'll all do better."
at 1:21 PM