Dive Brief:
- An Associated Press review found that Oregon's Medicaid expansion, touted as a potential national model, is encountering immediate challenges.
- Oregon added 360,000 low-income people to the Medicaid rolls this year, more than twice the number projected. That puts Oregon's total Medicaid enrollment at nearly 1 million, about a quarter of the state's population.
- This unexpected Medicaid influx has strained the capacity of the program's revamped network: locking out some enrollees, forcing others to have lengthy waits for medical appointments, and prompting an increase in emergency room visits—which the state had actively sought to avoid.
Dive Insight:
A primary care physician in Oregon told AP that: "As soon as people got insured, they all showed up at once, wanting to deal with the problems they couldn't deal with for years."
In anticipation of Medicaid expansion, Oregon set up 15 regional coordinated care organizations—regional networks of doctors and nurses to offer better access to care for small and chronic problems. But these organizations have confronted various problems. State data show two regions have stopped accepting new patients, locking out 16,000-plus new enrollees in western and southern Oregon, AP said. These enrollees, while still insured, are on their own to find doctors.
In eight regions, some practices, clinics and individual doctors closed to new Medicaid enrollees, AP found. Seven regions reported sometimes months-long waits for new enrollees seeking primary care visits, and seven regions reported an increase in ER visits of as much as 30%. Officials told AP that the rising ER use is likely fueled by newly-covered patients who cannot get primary care services.
Some said the expansion's immediate challenges underscore the severity of a national physician shortage also affecting Oregon, especially in rural areas. Proponents of the state's system overhaul said they are working to improve Medicaid enrollees' access to care, and pointed to Medicaid's influx of new enrollees in Oregon as proof that their efforts are needed and working.