Enrollees Have Difficulty Accessing Care under Medicaid

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from NCPA,

The Affordable Care Act incentivized states to expand their Medicaid programs to adults earning up to 138 percent of the poverty level, and many have done so; by 2015, the Congressional Budget Office expects an additional 11 million Americans to be enrolled in Medicaid. But enrollment in a health insurance program is no guarantee of access to health care. Writing for the Daily Signal, Alyene Senger cites a new report from the Department of Health and Human Services that details problems in health care access within Medicaid.

Analyzing Medicaid use from July 2013 to October 2013, the Department of Health and Human Services (HHS) evaluated the ability of enrollees in managed care Medicaid programs to access health care services. In a managed care model, states pay managed care organizations (MCOs) a fixed fee per Medicaid enrollee, and the MCOs contract with health care providers to deliver health services. Most states provide some amount of Medicaid services this way.

According to the HHS report:

– Fifty-one percent of the health care providers in these plans were not accepting new patients, were not actually participating at the location listed in the plan or were practicing at the location listed but were not participating in the Medicaid plan.

– For the 49 percent of providers who did offer appointments to new patients in Medicaid managed care plans, the median wait time for an appointment was two weeks, though the appointments offered ranged from the same day to an appointment nine months later.

– Twenty-eight percent of providers required enrollees to wait over a month for an appointment, while 10 percent required a wait of more than two months.

– Just 44 percent of primary care doctors offered new patients appointments, while 57 percent of specialists offered appointments. However, the median wait time for specialists was twice that of primary care providers: 20 days compared to 10 days.

The HHS study took place prior to states’ 2014 ACA Medicaid expansion.

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