Medicaid reimbursement, not expansion status, affects doctors' acceptance of new patients
Physicians in states where Medicaid rates are closer to Medicare reimbursement rates accept new Medicaid patients at a higher rate, according to a new analysis in Health Affairs. On average, Medicaid paid 72% of what Medicare reimbursed in 2016.
There were no significant differences in provider acceptance rates of new patients between states that expanded their Medicaid programs and those that did not, according to the report, which examined data from the Medicaid and Children's Health Insurance Program Payment and Access Commission. One exception was for OB/GYNs — 90% accepted new patients in non-expansion states compared to 74% in expansion states.
The review also found no difference in acceptance rates based on a state's Medicaid managed care offerings, which the authors said was similar to previous studies.
There are now more than 85 million people with Medicaid, and states expanding the program under the Affordable Care Act have provided coverage to about 14 million additional people.
For Medicaid to offer proper access to services, providers must actually accept the insurance, however. MACPAC found that lower rates of providers accept Medicaid than either Medicare or private insurance.
MACPAC contracted with the State Health Access Data Assistance Center at the University of Minnesota to analyze the 2014–15 National Ambulatory Medical Care Survey data. It found that only 71% of providers accepted Medicaid, which was compared to 85% for Medicare and 90% for private insurance. The percentages were much lower for psychiatry (36%) and slightly lower for primary care (68%).
One reason for the differences between Medicaid and other types of insurance is that Medicaid reimbursements are usually lower than Medicare. Those payments are typically much lower than private payers.
A recent Medscape survey found that more than 70% of physicians say they plan to continue to take on new Medicaid and Medicare patients, however. About 5% said they would not accept new Medicaid patients and 2% would stop treating some or all of those patients as well as refuse to take new ones.
Whenever there are changes to Medicaid, a leading concern is what it will mean for access to the program. Expansion critics have worried that increasing the program would lead to long wait times and access to care problems. However, MACPAC found that hasn't happened.
As states continue to look for ways to bend the Medicaid cost curve, leaders will need to be cautious when it comes to provider payments. Cutting Medicaid reimbursements as a way to reduce costs may only lead to more physicians not accepting new patients.