Taxpayers spend almost a half-trillion dollars each year to provide Medicaid coverage for about 70 million beneficiaries. With continued implementation of
the Patient Protection and Affordable Care Act, it is estimated that Medicaid will cover an additional 18 million Americans by 2018.
HHS' Office of Inspector General is charged with overseeing the Medicare and Medicaid programs to ensure that taxpayer money is properly spent and beneficiaries are appropriately served. We recently evaluated Medicaid beneficiaries' access to physician services, reviewing state standards and testing beneficiaries' real-world ability to obtain appointments with primary-care and specialty physicians. Our findings demonstrate substantial need for improvement.
Federal law requires states to establish access-to-care standards for the Medicaid managed-care plans in which a growing number of beneficiaries are enrolled. We found significant state-to-state variation in network adequacy standards. For example, while Wisconsin requires one primary-care provider for every 100 Medicaid enrollees, Delaware and Tennessee require only one primary-care provider for every 2,500 Medicaid enrollees, and other states specify no minimum provider number.
The District of Columbia specifies a maximum allowable travel burden of five miles or 30 minutes, while Mississippi allows for a maximum of 60 miles or 60 minutes. Maximum allowable wait times to see a primary-care provider for a routine appointment range from 10 days in California and Pennsylvania to 45 days in Massachusetts and Minnesota. Moreover, states often fail to enforce or test their standards. My office tested the ability to schedule timely Medicaid appointments, with discouraging results.
When our evaluators tried to schedule appointments with physicians listed by Medicaid managed-care plans, they encountered frequent failure. For half of the scheduling attempts, the physician could not be found at the location listed, was not serving Medicaid patients or, though still participating in the Medicaid plan, was not accepting new Medicaid patients. Only a quarter of physicians offered appointments within two weeks of the contact date.
What can be done to improve Medicaid beneficiaries' access to outpatient physician services?
First, Medicaid managed-care plans should maintain an adequate network of providers as well as accurate and updated provider directories. Many provider directories that Medicaid beneficiaries rely on are inaccurate and outdated. Plans should offer a website or phone number where beneficiaries can access an up-to-date list of network physicians with accurate office locations and contact information.
Second, states must establish and maintain appropriate access-to-care standards and effectively enforce those standards to ensure that beneficiaries are adequately served.
Third, health plans and states should consider additional tools or resources to make it easier for patients to schedule timely medical appointments, including, for example, the use of technology such as electronic scheduling systems or dedicated personnel to assist beneficiaries.
Access to timely medical care is critical to improving the quality of care and may help reduce unnecessary costs resulting from delayed care. Our testing was limited to the Medicaid program, but other sources suggest that access to timely care and accurate provider information are not exclusively issues for patients in Medicaid managed care.
The American public makes a substantial financial investment in Medicaid and other healthcare programs. Taxpayers' financial investments must be well-spent and program beneficiaries should have access to care that meets their medical needs. Making it easier for patients to connect with healthcare providers is a critical step toward meeting these goals.
Dr. Julie Taitsman is chief medical officer with HHS' Office of Inspector General in Washington.