A provision of the Affordable Care Act that requires providers to revalidate or recertify their Medicaid reimbursement eligibility has caused more than 65,000 providers to be stripped from the federal program, according to a Modern Healthcare analysis.
Providers that enrolled in Medicaid before March 25, 2011, had to send in revalidation notices to the CMS on or before Sept. 25, 2016, or risk being dropped.
The move was an effort to curb fraud, waste and abuse in the program.
Modern Healthcare received data from 15 Medicaid agencies around the country. There is no nationwide tally of the total number of providers that accept Medicaid.
But to give a ballpark estimate on impact, Texas cut more than 28,000, or nearly 10%, of its 298,000 Medicaid providers.
Some states were successful in receiving revalidation notices from providers, while others are just now evaluating their rolls because of staffing or technical limitations, according to officials at state Medicaid agencies.
States say many providers left Medicaid voluntarily. The programs have long been criticized in many states for low reimbursement, often paying 60% of the Medicare rate for medical services.
Indiana, which dropped 3,226 providers, found many providers left the state, enrolled for a single patient or no longer wished to participate, according to Jim Gavin, a spokesman for the state's Medicaid agency. Washington and Tennessee officials made similar comments.
The Medical Association of Georgia learned that letters mailed to providers were returned because addresses were not updated in the state's Medicaid system. It's unclear how many providers were ultimately un-enrolled.
A state Medicaid agency spokeswoman did not reply to a request for comment. Some providers worry that scrubbing doctors off state rolls will dilute access to care.
“The loss of any provider is dispiriting and will likely jeopardize patient access to care given concerns about network adequacy,” a spokesman for the Texas Medical Association said.
The American Medical Association and American Academy of Family Physicians said they haven't heard complaints about access.
And according to a report from the National Center for Health Statistics, about 69% of office-based physicians were accepting new Medicaid patients while around 84% accepted new Medicare patients.