Providers are less likely to accept Medicaid patients than people on other types of health insurance, according to a new Medicaid and Children's Health Insurance Program Payment and Access Commission report.
Medicaid expansion under the Affordable Care Act has had no impact on whether doctors accept the insurance. MACPAC didn't find any difference between Medicaid expansion and non-expansion states except for obstetrician/gynecologists. Those specialists were more likely to accept new Medicaid patients in non-expansion states than expansion states (90% compared to 74%).
One likely reason fewer doctors accept Medicaid patients is that those claims are paid at a lower rate than other insurance. More providers would be interested in Medicaid if the program's reimbursements were similar to Medicare payments, according to the report.
MACPAC found that only 71% of providers accept Medicaid. That's compared to 85% who take Medicare and 90% that accept private insurance.
Physicians in general/family practice were less likely to accept Medicaid patients (68%) than Medicare (90%) or private insurance (91%). Only 36% of psychiatrists accepted new Medicaid patients compared to 62% who took Medicare patients and also 62% who accepted on private insurance.
Pediatricians accepted new Medicaid patients at a lower rate (78%) than privately insured patients (91%). However, pediatricians had one of the highest percentages of specialists who accept Medicaid patients. Only general surgeons and obstetrician/gynecologists had higher rates and all three were higher rates than physicians overall.
While lower reimbursement is a main cause for physicians not taking new Medicaid patients, states raising those payments would result in added costs for strapped budgets. States are looking for ways to cut Medicaid costs — including through work requirements and managed care programs.
Nevertheless, the report suggested that increasing Medicaid payments to just Medicare levels could result in more physician interest. That could help with potential access issues for Medicaid patients.
The MACPAC report came a day after the commission voted to recommended phasing in payment cuts to disproportionate share hospitals, as well as changing the methodology for allocating spending. The group said the changes could save between $1 billion and $5 billion over a decade. MACPAC plans to make those recommendations in the committee's annual report this year.
Medicaid expansion in the Affordable Care Act was supposed to reduce the numbers of uninsured Americans. The ACA also included cutting DSH payments since Medicaid expansion would theoretically cut uncompensated care costs.
Congress has put off DSH payment cuts since 2014. Capitol Hill will need to decide by Sept. 30 whether to go through with the DSH payment cuts for fiscal year 2020.