Dive Brief:
- Due to an increase in the income eligibility range under the Affordable Care Act, Medicaid enrollment in expansion states grew by 9 million beneficiaries between 2013 and 2014 alone.
- According to a report in HealthPocket, although Medicaid enrollment continues to rise, the number of primary care physicians who are participating continues to decline; and many physicians who do accept Medicaid are no longer taking on new patients.
- The main reason for the decline in participation is that reimbursement for Medicaid is less than for other insurers, including Medicare. Other reasons why primary care physicians are opting out include onerous administrative processes associated with the Medicaid program and slow reimbursement.
Dive Insight:
The increase in Medicaid beneficiaries coupled with a decrease in Medicaid providers could lead to a surge in emergency room use. According to the Medicaid and Children's Health Insurance Program Payment and Access Commission, Medicaid patients already visit the ED more frequently than patients with private insurance or those who are uninsured; and part of that problem can be attributed to their inability to find access to primary care. "Even those Medicaid patients who have primary care physicians—and that is less likely than for people with private insurance—report significant barriers to seeing their doctor," said Adit Ginde, MD, MPH, FACEP, in a study that was published in the Annals of Emergency Medicine. "Medicaid patients tend to visit the ER more, partly because they tend to be in poorer health overall. But they also visit the ER more because they can't see their primary care provider in a timely fashion or at all."