Medicaid Reimbursement Increases Improved Access to Care

The Affordable Care Act's mandate to increase Medicaid reimbursement to primary care providers has improved access to care for Medicaid enrollees, according to analysis of early evidence published in the New England Journal of Medicine.

The Affordable Care Act’s mandate to increase Medicaid reimbursement to primary care providers has improved access to care for Medicaid enrollees, according to analysis of early evidence published in the New England Journal of Medicine.

Daniel E. Polsky, PhD, of the University of Pennsylvania School of Medicine, and colleagues examined the association between the increase in Medicaid payments and appointment availability for Medicaid enrollees.

“Provider access is of particular concern for the Medicaid program, which is set to absorb the bulk of newly insured persons in many states, because Medicaid typically reimburses providers at much lower payment rates than those of Medicare and commercial insurers for the same services,” the authors wrote. “Lower payments have been cited as a critical barrier to access for primary care among Medicaid enrollees and are associated with lower provider availability for Medicaid patients.”

They estimated appointment availability in late 2012 to early 2013 and again in mid-2014 by using staff members to simulate patients seeking a new-patient appointment at primary care offices in Arkansas, Georgia, Illinois, Iowa, Massachusetts, Montana, New Jersey, Oregon, Pennsylvania, and Texas. Offices were selected at random and the simulated patients were assigned an insurance type at random.

Appointment availability for private-insurance callers stayed steady at 86% before and after the reimbursement increase, but appointment availability for Medicaid callers increased from 58.7% during the first set of calls to 66.4% during the second set of calls. New Jersey, Pennsylvania, Illinois, and Texas had the largest increases in Medicaid appointment availability and were also states with the largest increases in Medicaid reimbursements.

According to the researchers, there was strong evidence that providers who were participating in Medicaid in 2012 were more willing to schedule new-patient appointments with Medicaid beneficiaries in 2014.

The federal government has not extended funding for reimbursement increases and only 15 states plan to continue the reimbursement increases on their own.

“Our analysis shows that opting not to extend the enhanced payments may significantly decrease the availability of primary care appointments for Medicaid enrollees, particularly in states that had low Medicaid reimbursements before the increase,” the authors wrote.