Vital Signs Blog

Blog: More providers than previously thought accept Medicaid patients

A long-running belief may have just been refuted: There may be more providers willing to see Medicaid patients than previously estimated.

Patient advocates argue that providers are often unwilling to take on Medicaid enrollees because reimbursement rates can be as little as 60% of the costs of care. That concern has even led to lawsuits. In 2015, the U.S. Supreme Court ruled that private healthcare providers cannot sue state Medicaid agencies over low reimbursement rates.

Idaho providers had argued in the case, Armstrong v. Exceptional Child Center Inc. that suing over low rates is sometimes the only way to enforce federal payment requirements. Otherwise, low rates could lead to fewer providers agreeing to participate in Medicaid, and thus less access to care for Medicaid patients.

Physicians, meantime, have argued that with only so many hours in a day, why would they devote time to serving the lowest-paying patients?

In 2013, the last time Health Affairs published a physician survey on the question, the researchers found nearly 1 out of 3 doctors refused to see new Medicaid patients. That was compared to just 17% of physicians who refused to see new Medicare patients&msash;and those were the ones who admitted it.

But a new analysis by the Medicaid and CHIP Payment and Access Commission (MACPAC) could be turning that belief on its head.

Still, while more physicians than previously believed take on Medicaid patients, MACPAC found that many physicians only serve five or fewer Medicaid patients in their practice. Among specialists, there were some states where as many as 61% of psychiatrists had five or fewer Medicaid patients. And as many as 53% of OB-GYNs in some states reported the same patient numbers.

The Commission was quick to point out that its findings were preliminary, and that additional validation and refinement are still needed.

MACPAC's findings are important because most estimates on the willingness of providers to see Medicaid patients come from national surveys. The National Ambulatory Medical Care Survey is considered the leading resource.

However, that survey is limited in that responses are self-reported by physicians who tend to be in an office versus an outpatient setting, according to MACPAC. The survey also doesn't track specialists' patient uptake.

Every provider who bills a third-party program like Medicaid receives a national provider identifier (NPI). To get a more accurate sense of care access for Medicaid beneficiaries, MACPAC did a retroactive analysis of NPI claims data in the national database called the Medicaid Statistical Information System.


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