Dive Brief:
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The Affordable Care Act temporarily increased Medicaid payments to qualifying primary care physicians and services, a move aimed at improving primary care access for enrollees. However, a new JAMA report found that the limited time frame and design curbed the program’s effectiveness.
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Researchers found that the higher compensation didn’t increase PCP participation in Medicaid.
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Study authors from the RAND Corporation and HHS looked at IMS Health medical claims and encounter data for more than 20,000 eligible PCPs between 2012 and 2015.
Dive Insight:
The ACA included the limited time payment increase at the same time that it allowed states to expand their Medicaid programs. Expansion in 34 states and the District of Columbia has led to more than 14 million people getting health insurance.
The claims data included services performed in ambulatory settings, such as office, hospital outpatient departments and emergency departments.
Study authors said their findings are contrary to other evidence suggesting payment increases improve physician participation. Possible factors for their findings include the program's delayed payments, the pay increase only lasting two years and doctors needing to submit documentation to qualify for more money.
“Policymakers should consider these empirical findings (as well as qualitative research on the outcomes of the payment increase) when designing potential future payment increases and comparing them with other possible strategies to improve access,” according to the report.
Increasing payments to doctors is just one way to improve Medicaid patient access.
Investing in health centers, increasing workforce supply in underserved communities and telehealth are all methods for improving access to care for Medicaid enrollees, the study noted.
Though the report found that increasing payments didn't improve patient access, other studies have found that Medicaid expansion did increase coverage and overall access to care and quality. A recent Health Affairs analysis of more than 70 studies on the subject found expanding Medicaid resulted in more use of primary care, mental health and preventive visits. There were decreased hospital lengths-of-stay among newly insured beneficiaries as well.
Despite care access improvements, Medicaid expansion has also caused states to search for ways to cut program costs, especially those with Republicans in charge.
Kentucky became the first state to get a work requirement waiver that would require non-disabled Medicaid recipients to work. Three other states have since received similar waivers. However, a federal judge recently invalidated Kentucky’s CMS approval. The decision questioned whether the state considered how the requirement could impact Medicaid’s goals and the patient population’s health. Kentucky, in turn, cut vision and dental coverage for as many as 460,000 people on Medicaid.
Medicaid expansion remains a hot political issue. However, the recent Health Affairs report found current studies show the program’s expansion has led to “more improvements in various outcomes than negative effects with respect to the main goals of the ACA.”