Under the Patient Protection and Affordable Care Act, some 16 million more people are expected to receive Medicaid coverage by 2019, but according to a Center for Studying Health System Change research brief, most of those new patients in the system live in states where primary-care physician shortages are looming or where a large segment of these doctors are not seeing new Medicaid patients.
Doc supply won't keep pace with Medicaid enrollment: report
In fact, the report concludes that "most of the nation will likely observe Medicaid enrollment increases that exceed increases in Medicaid (primary-care physician) supply."
Based on 2008 data from the Health Resources and Services Administration’s area resource file, 42% of all primary-care physicians are accepting all or most new Medicaid patients, compared to 61% accepting all or most new Medicare patients or 84% of those with private insurance. Researchers calculated that the Medicaid primary-care physician supply is 1.67 times higher in states with a high primary-care supply versus those in states where there is a low supply—with "supply" based on a ratio determined by the number of primary-care physicians and the U.S nonelderly population (with 25% of the population going into high primary-care states, another 25% in low primary-care states, and 50% in states with a medium supply).
States with the highest levels of primary-care doctors are concentrated in the Mid-Atlantic region and in the Northeast, while states with the lowest supply are in the South and Mountain West. The report notes, however, that there is little difference between states with a high primary-care supply and a low primary-care supply in terms of the nonelderly population enrolled in Medicaid. The 1.67 figure was based on how there were 38.2 primary-care physicians accepting Medicaid patients for every 10,000 nonelderly enrollees in high primary-care states compared to 22.9 in low primary-care states.
To address possible primary-care shortages, the reform law calls for a temporary increase in Medicaid reimbursement for primary care, but the researchers noted that Medicaid reimbursement rates were generally higher in the low primary-care states in the South and Mountain West already, so any reimbursement increase likely would have less impact on increasing the supply of Medicaid primary-care physicians in these states than it would in high-primary-care physician states.
Researchers note, however, that efforts to better integrate and coordinate specialty and primary care may offset some shortages. It was also noted that more organized systems of care may result in decreasing the administrative burdens often cited by physicians as the reason for declining to see more Medicaid patients.
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