The Doctor is Not In (for Medicaid Patients)



With pressure from the federal government to expand enrollment, Medicaid costs represent a rising chunk of state budgets around the country—one that's crowding out other priorities. State officials desperate to control costs are stiffing health care providers and turning to managed care. Low reimbursement (which is about to get worse) already discourages doctors from accepting Medicaid patients. And last month, the Office of the Inspector General for the Department of Health and Human Services found that managed care isn't magically closing the gap. Medicaid may be signing up new customers, but there's a shortage of doctors willing and able to care for them.

Specifically, Access to Care: Provider Availability in Medicaid Managed Care (PDF) says:

We found that slightly more than half of providers could not offer appointments to enrollees. Notably, 35 percent could not be found at the location listed by the plan, and another 8 percent were at the location but said that they were not participating in the plan. An additional 8 percent were not accepting new patients. Among the providers who offered appointments, the median wait time was 2 weeks. However, over a quarter had wait times of more than 1 month, and 10 percent had wait times longer than 2 months. Finally, primary care providers were less likely to offer an appointment than specialists; however, specialists tended to have longer wait times.

Read that again. More than a third of the providers listed as available to patients aren't even at the address listed. They may be down the street or in another state, but the contact information provided for them is worthless.

Another 16 percent aren't taking Medicaid patients—whether that means "at all" or just that they've closed their practices to new ones doesn't matter to new enrollees who are shut out either way.

And the OIG report was prepared before temporarily hiked reimbursements to providers, intended to encourage Medicaid expansion, expired at the end of 2014. As of January 1, 2015, physicians are seeing "an average 42.8 percent reduction in fees for primary care services," according to the Urban Institute (actual percentages vary by state, and a few states are maintaining part or all of the "fee bump" out of their own funds).

That just might make it even harder to find providers willing and able to offer appointments to Medicaid enrollees.

Note: My wife is a pediatrician who sees many Medicaid patients as part of her practice in rural Arizona. She anticipates a roughly 30 percent drop in reimbursement for them.