The ratio of in-network primary-care providers to plan enrollees is a common measure of network adequacy.
Also, among plans required to maintain a specified minimum provider-to-enrollee ratio, the average required ration was one provider for every 1,385 enrollees.
Federal rules require Medicaid managed care plans to maintain a network of appropriate providers large enough to provide adequate access to all of their enrollees, however states have differing measures of network adequacy.
The plans reported some challenges in maintaining those networks during the state budget cuts of recent years. Specifically, only nine out of 29 responding Medicaid plans reported that they absorbed some or all of the state’s recent rate cuts and did not pass these on to their providers.
Also, 77% of plans reported that provider payment rates were the primary reason providers outside the plan’s network chose not to participate, and 48% blamed low provider payment rates as the reason in-network providers limited their participation in the plan’s network.
Coming temporary increases in Medicaid reimbursement for some primary-care services to at least the Medicare level is expected by 45% of plans to help attract more providers. However, six of 29 plans report paying at or close to the Medicare rates and so expect little impact from the increase.