enrollments through the new health exchange
in Washington state have exceeded officials' expectations, but questions remain about whether there will be enough doctors
to serve the influx of newly insured low-income patients.
The state Health Care Authority, which oversees the federal-state program for the poor and disabled, is in talks with the University of Washington and the Washington State Medical Association to do a statewide survey of doctors this summer to see if the federal health law's temporary bump in Medicaid payments to doctors was an incentive that helped keep or add providers.
While officials had originally estimated that approximately 120,000 newly eligible adults would initially sign up for Medicaid in Washington state, about 300,000 actually did.
That bump in doctor pay — bringing the reimbursement rates up to the same level as Medicare, the federal program for those 65 and older — was part of the Affordable Care Act and meant to address doctors' complaints that Medicaid reimbursements were too low. That increase will last until the end of the year. Medicaid rates are generally about two-thirds of Medicare rates, according to an estimate from state officials.
Dr. Daniel Lessler, the chief medical officer for the state Health Care Authority, said that a survey could help the state see if there are other potential barriers, other than reimbursement rates, for providers taking on more Medicaid patients.
"It just helps us to understand how we can best work to maintain an adequate primary care workforce that accepts Medicaid patients," he said.
According to the Washington State Medical Association, there are just shy of 6,000 active primary care physicians in the state.
Dr. Dale Reisner, the association's president, said that while there are probably enough licensed providers in the state, the challenge is figuring out which doctors are currently accepting Medicaid and what percentage of their practice is Medicaid.
"Prior to the bump provided by the ACA, the cost of providing care to Medicaid recipient is a loss to most providers," she said. "So that's been the thing we're trying to grapple with. How many providers who are already taking Medicaid patients have expanded the percentage they're taking?"
A research brief issued by the state's Office of Financial Management that looked at whether the current number of primary care physicians could handle an influx of Medicaid patients found that the answer "is not a clear-cut yes or no."
While statewide, there are enough providers to absorb more patients, numbers vary regionally, officials found. According to the 2012 OFM report several areas on both sides of the state were expected to fall short of needed capacity. Two non-urban regions, located in the westernmost part of the state, and in the southwest corner, are expected to have the biggest challenges, with only one-fifth of the needed capacity, according to the report.
Lessler said officials already knew that access to doctors, especially in rural areas, would be difficult.
"That was a problem before Medicaid expansion and it's a problem now," he said.
In an effort to increase Washington's primary care workforce, a state budget proviso authorized by the Legislature last year allowed naturopaths to receive Medicaid reimbursements as primary care providers.
The goal of the proposed survey, officials said, is to have data available by the fall so that lawmakers can have a better sense of the state of access to care when the Legislature reconvenes in January, giving them time to potentially consider incentives to extend or add to help expand the Medicaid network.
Washington state is among 26 states that have expanded eligibility to Medicaid to people who earn less than 138 percent of the federal poverty line, or about $16,104 a year for a single adult. Previously there was no Medicaid program for nondisabled childless adults between the ages of 18 and 65.
The number of people enrolled for Medicaid in Washington state, previously at 1.2 million, has jumped by 450,000 adults since Oct. 1. About 300,000 of those enrollees were newly eligible for the program, while the rest were previously eligible but did not sign up until the new health exchange started up.
Audra Lutz, the clinic manager for SeaMar Community Health Clinics in Aberdeen and Ocean Shores, said her clinics, which already have a high percentage of Medicaid patients, have seen a nearly 10 percent increase in patients at the two clinics since the Medicaid expansion.
She said they've added providers and have expanded hours to address the increase.
"I think certainly a lot of the health centers had their fingers on the pulse and were trying to expand as we went so we weren't overwhelmed," she said. "People weren't really sure what was going to happen. Was it going to be a tidal wave or was it going to be a trickle?"
Peter Adler, president of Molina Healthcare of Washington, said that the company has been expanding its primary care network over the past 18 months in anticipation of the increase.
Molina, which is the state's largest Medicaid managed-care plan provider, has expanded its Medicaid network in the state by 34 percent and currently has more than 4,100 providers.
"We have not had primary care access bottlenecks," Adler said.