Patient Care Access News

Medicaid Patient Healthcare Access on Par with Private Plans

Seventy percent of doctors now accept Medicaid patients, driving healthcare access for low-income individuals.


Source: Thinkstock

By Sara Heath

- Medicaid-covered patients experience near equal healthcare access when compared to their privately-insured counterparts, according to a data note from the Kaiser Family Foundation (KFF).

“Given Medicaid’s major coverage role and the complex health care needs of the population it covers, data and evidence on access to care and health outcomes in Medicaid are of key interest,” reported KFF Associate Director of the Program on Medicaid and the Uninsured Julia Paradise.

“Such an assessment is also important to ensure that debate about the effectiveness of the Medicaid program is grounded in facts and analysis.”

While Medicaid is an imperfect program, it does help connect patients to providers. It also facilitates disease detection and management for the 74 million low-income beneficiaries it serves.

Overall, Paradise’s research yielded three key findings indicating Medicaid’s success at fostering patient healthcare access.

READ MORE: What Providers Should Know to Improve Patient Access to Healthcare

Most doctors now accept Medicaid patients

According to Paradise, 70 percent of doctors accept new Medicaid patients, compared to 85 percent of doctors who accept new Medicare or privately-insured patients.

However, Medicaid patient healthcare access varies by state. In Nebraska, 97 percent of doctors accept new Medicaid patients, while in New Jersey that number is only 39 percent.

More states perform above average than below average. Twenty-five states have significantly higher rates of Medicaid patient acceptance than the national average. Only five states have significantly lower rates of Medicaid patient access, while 20 states have access rates right around 70 percent.

Overall, specialists and pediatricians are more likely to accept new Medicaid patients than primary care physicians. Psychiatrists are least likely to accept Medicaid patients than any other provider type.  This finding was unsurprising for Paradise, who noted that psychiatrists are unlikely to accept any kind of insurance, whether it be private or public.

READ MORE: Senate Bill Boosts Patient Access to Care in Rural Regions

Despite some care gaps, it is significant that most community health centers and other primary care providers offer a healthcare network to low-income Medicaid patients.

“Virtually all doctors who practice in community health centers, which are a key source of primary care in low-income communities, accept new Medicaid patients,” Paradise said. “Well over half of Medicaid beneficiaries are enrolled in contracted managed care plans, which are responsible for ensuring adequate provider networks and access to care for their Medicaid members.”

Medicaid patients fare equally to privately-insured patients

Paradise also found that Medicaid patients can obtain doctor’s appointments nearly as easily as privately-insured patients. Many recent studies confirm that despite Medicaid expansion under the Affordable Care Act (ACA), patient healthcare access is still high.

Ninety-five percent of pediatric patients on Medicaid/Children’s Health Insurance Program (CHIP) have a regular source for healthcare. These children are equally as likely to receive well-child and specialist care as privately-insured children, Paradise reported. Four percent of Medicaid/CHIP children have trouble finding a primary care physician, while 2 percent of privately-insured patients have the same issue.

READ MORE: Does the ACA Drive Patient Access to Primary Preventive Care?

Non-elderly adults also have ample healthcare access under Medicaid. Ninety-percent of adult beneficiaries have regular PCP access, and these patients also receive preventive care and screenings at equal rates to their privately-insured counterparts.

Eleven percent of adult Medicaid patients have trouble finding a PCP, compared to 6 percent of privately-insured patients. Doctor availability tends to be the biggest obstacle, Paradise explained.

The uninsured fare significantly worse when compared to Medicaid and privately-insured patients. These patients are more likely to forgo or delay healthcare and have an irregular source of treatment than covered patients.

Medicaid’s healthcare access does have its limitations, Paradise pointed out.

“Gaps in access to certain providers, particularly psychiatrists and dentists, are ongoing challenges in Medicaid,” she said.

“These and other gaps in access tend to mirror system-wide access problems that also affect Medicare and the private insurance market, but they are exacerbated in Medicaid by provider shortages in low-income communities, lower physician fees and participation in Medicaid compared to private insurance, and lack of transportation.”

Emerging evidence on Medicaid outcomes measures

Because more low-income individuals can access healthcare through their Medicaid benefits, patients are seeing better disease detection and care management.

“Access to screening and preventive care in Medicaid translates into well-child care and earlier detection of health and developmental problems in children, earlier diagnosis of cancer, diabetes, and other chronic conditions in adults, and earlier detection of mental illness in people of all ages,” Paradise observed.

“Access to physician care, prescription drugs, emergency care, and other services improves the likelihood that Medicaid enrollees will get treatment for both their acute and chronic conditions.”

Citing one Oregon-based study, Paradise noted that previously uninsured patients have better mental healthcare and depression management under their Medicaid coverage.

And while the Oregon study did not show improvements in outcomes measures, it did find that newly-covered Medicaid patients had better self-management techniques. For example, the number of diabetes detections increased, as did medication prescriptions and management.

“The purpose of health insurance is to increase access to care and provide protection against high out-of-pocket costs,” Paradise said, pointing out Medicaid’s positive effect on chronic disease management.

“Health outcomes are determined by a large number of variables, from genetic factors to social supports and environmental processes, and direct evidence that Medicaid or any other type of health coverage improves not just access to care, but also health outcomes, is limited,” she continued.

Despite these promising data points, Paradise noted that Medicaid is still an imperfect program, and requires more research and support to effectively support its beneficiaries and participating providers.

“Data and research provide evidence that Medicaid provides effective access to care for those it covers, including many of the poorest and sickest people in our nation,” Paradise concluded.

“While the Medicaid program could be strengthened and improved, limiting the scope of Medicaid is likely to jeopardize access to care for the population most in need, with adverse consequences for their health and well-being in the near term and beyond.”


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