Medicaid Beneficiary Access to Care Revisited

It has been an interesting month for those of us concerned about access to care for Medicaid beneficiaries.

First, the HHS Office of Inspector General relased a report surveying access to primary care providers and specialists in Medicaid  managed care.  Guess what? The plan directories were highly inaccurate as to basics such as provider name and location. Even when when accurate,  the directories listed many providers who were not accepting new Medicaid patients.  Even among those who could be located, were accepting Medicaid and indicated a willingness to accept new patients, five percent had appointments available only after a three month wait.

Second, the Urban Institute has issued a report discussing the likely Medicaid access implications of the scheduled termination of the ACA-generated Medicaid primary care fee bump on December 31, 2014. Interestingly, the fee bump appears poised to terminate on time even though most participating states were not able to implement until the second half of 2013. Although participants were eligible for retroactive bump payments, it is likely that uncertainty over the mechanics and duration of the bump helped to dampen participation.

What did we learn?  That is takes a long time for the bureaucracy to roll out a time-limited Medicaid fee bump. What we don't know is whether an increase in Medicaid primary care payment has produced an increase in primary care access for Medicaid beneficiaries or if any increase in the number of Medicaid participating physicians is national, regional, or local in scope.

Let's hope that the fifteen participating states that have announced their intention to continue the fee bump (using state funds) may actually keep it going long enough for us to learn something.  

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