Medicaid Acceptance by Healthcare Providers Drops to 1-out-of-3
Drop in Medicaid acceptance occurs as reimbursement rates decline for primary care physicians in many states
When HealthPocket first investigated Medicaid acceptance in 2013, it found that only 43% of the healthcare providers examined were formally listed as accepting Medicaid.1 Since the original 2013 study, Medicaid enrollment has continued to rise as the Affordable Care Act has led many states to increase the income eligibility range for the program.2 Medicaid, along with the Child Health Insurance Program (CHIP), currently covers approximately 1-in-5 people in the United States.3 This year, the temporary increase4 in Medicaid payments to primary care physicians discontinues with only 15 states indicating that they intend to maintain the payment increase (fully or partially).5 The reduction in Medicaid reimbursement to primary care physicians has brought with it a concern that Medicaid acceptance, already low among healthcare providers, will drop further.
Given the size of the Medicaid program and its importance to America’s low-income population, HealthPocket repeated its examination of Medicaid acceptance using updated 2015 data for the same categories of healthcare providers examined in the original study.6 In both the 2013 study and the 2015 study, over a million healthcare provider records were analyzed with respect to Medicaid acceptance.
HealthPocket found that in 2015 only 34% of the healthcare providers examined were listed as accepting Medicaid insurance. This represents a 21% decrease from the listings of Medicaid acceptance found in the 2013 data for the same categories of healthcare providers.
Since both the 2013 analysis and 2015 analysis relied upon the same government data source and provider record parameters, the marked decline in Medicaid acceptance is significant. In particular, the data calls into question whether the temporary increase in Medicaid payments to primary care physicians effected any lasting improvements to Medicaid acceptance.
Why Do Some Healthcare Providers Avoid Medicaid?
Given the number of people served by the Medicaid program, it surprises some people outside the healthcare field that Medicaid does not have wider acceptance among healthcare providers. A common explanation given for Medicaid lower acceptance is the program’s reimbursement rate to healthcare providers. Medicaid typically pays 61% of what Medicare pays for the same outpatient physician services.7 To make matters worse, the Medicare payment benchmark is already lower than payments for the same services from private insurers. It is estimated that Medicare typically pays 80% of what commercial health insurers pay.8 Consequently, in comparison to commercial health insurance from private insurance companies, Medicaid payments represent a reduction on a reduction.
There are additional factors beyond reimbursement rates that have also negatively affected Medicaid acceptance among healthcare providers. A 2013 study9 published in HealthAffairs included the following recommendations to increase Medicaid acceptance based on physician feedback captured in survey and focus group research:
- Simplify the administrative processes associated with the Medicaid program to lower the costs of physician participation
- Improve the speed of reimbursement from Medicaid to physicians
- Reduce the costs associated with the care for Medicaid patients
The problem of limited Medicaid acceptance has been discussed for years. One of state governments’ responses to the problem is the use of managed care organizations to serve some portion of a state’s Medicaid population.10 However, as a 2014 Health & Human Services study noted, state standards regarding the ratio of primary care physicians to Medicaid managed care enrollees can vary widely (1-to-100 to 1-to-2,500) as do their methods for determining compliance with these standards.11 Consequently, Medicaid enrollees can face the prospect of long distances and/or long waits to access care under the program.12
Senator Tom Coburn observed, “Medicaid shows that access to a government health care program does not guarantee access to health care.”13 HealthPocket’s comparison of Medicaid acceptance listings from 2013 to 2015 illuminates an alarming trend for those dependent on Medicaid for their healthcare: a reduction in Medicaid acceptance occurring during a period of Medicaid enrollee expansion. How federal and state governments will reverse this trend remains to be seen. The temporary increase in Medicaid payments to primary care physicians from 2013 to 2014 does not appear to have produced a lasting increase in Medicaid acceptance and the expiration of this increase may contribute to further healthcare provider attrition from the Medicaid program. Consequently, a broader set of interventions may be necessary to make long-term improvements to Medicaid acceptance among healthcare providers.
Medicaid acceptance among healthcare providers was determined from National Provider Identifier (NPI) Registry records managed by the Centers for Medicare & Medicaid Services (CMS). Individual healthcare providers may only have a single NPI, which, in turn, is associated with their unique healthcare provider information including the taxonomy code indicating their service classification.
1,327,548 NPI records were examined for healthcare providers whose taxonomy code had their first three digits within the range 207 to 247. NPI data was collected on February 23, 2015.
All analysis assumes the accuracy of the underlying government data. While every effort was made towards to enhance data accuracy, HealthPocket makes no representation that every healthcare provider in the selected geographies were included in this study.
Percentages are rounded according to standard industry practices.
This analysis was completed by Kev Coleman, Head of Research & Data at HealthPocket.com. Correspondence regarding this study can be directed to Mr. Coleman at firstname.lastname@example.org.
Feedback and questions are welcome but, given the volume of email, personal responses may not be feasible.Kev Coleman on Google+
1 HealthPocket had used government National Provider Identification (NPI) registry records to determine the incidence of Medicaid acceptance. Kev Coleman. “With Expansion Looming, Less Than Half of Physicians Accept Medicaid” HealthPocket.com. (May 1, 2013). http://www.healthpocket.com/healthcare-research/infostat/less-than-half-of-physicians-accept-medicaid. Last accessed February 24, 2015.
2 http://medicaid.gov/affordablecareact/affordable-care-act.html Last accessed February 25, 2015.
3 Kimberly Leonard. “Medicaid Enrollment Surges Across the U.S.” U.S. News & World Report. (Feb. 24, 2015). http://www.usnews.com/news/articles/2015/02/24/medicaid-enrollment-surges-across-the-us. Last accessed February 24, 2015.
4 “To prepare the primary care workforce for the influx of new Medicaid-eligible patients established through the Affordable Care Act (ACA), this provision increases payment rates for certain primary care services to at least the level of Medicare in 2013 and 2014. The provision, often referred to as the Medicaid Primary Care Pay Parity program was included because primary care physicians, including internal medicine subspecialists who provide primary care, will be particularly affected by the Medicaid expansion since millions of new patients will enter the health care system and many will have complex health care needs.“ Taken from “Enhanced Medicaid Reimbursement Rates for Primary Care Services.” Unpublished work ©2014. American College of Physicians, Inc. http://www.acponline.org/advocacy/where_we_stand/assets/v1-enhanced-medicaid-reimbursement-rates.pdf. Last accessed February 25, 2015.
5 Laura Snyder, Julia Paradise, and Robin Rudowitz. “The ACA Primary Care Increase: State Plans for SFY 2015.” Kaiser Family Foundation. (Oct 28, 2014). http://kff.org/medicaid/perspective/the-aca-primary-care-increase-state-plans-for-sfy-2015/. Last accessed February 24, 2015.
6 HealthPocket examined over 1 million NPI records for healthcare providers whose taxonomy code had their first three digits within the range 207 to 247. See for more information on provider classification within the NPI, see “Health Care Provider Taxonomy Code Set” on https://www.wpc-edi.com/Reference/. Last accessed February 24, 2015.
7 Peter Ubel. “Why Many Physicians Are Reluctant To See Medicaid Patients.” Forbes. (11/07/2013). http://www.forbes.com/sites/peterubel/2013/11/07/why-many-physicians-are-reluctant-to-see-medicaid-patients/. Last accessed February 25, 2015.
8 Differences vary by specific procedure. Tami Luby. “Medicare vs. private insurance: Which costs less.” CNN Money. (April 21, 2014). http://money.cnn.com/2014/04/21/news/economy/medicare-doctors. Last accessed February 25, 2015.
9 Sharon K. Long. “Physicians May Need More Than Higher Reimbursements To Expand Medicaid Participation: Findings From Washington State.” HealthAffairs. vol. 32 no. 9 1560-1567. (September 2013). http://content.healthaffairs.org/content/32/9/1560.abstract Last accessed February 25, 2015.
10 Robert Book. “Benefits and Challenges of Medicaid Managed Care.” Forbes. (10/18/2012). http://www.forbes.com/sites/aroy/2012/10/18/benefits-and-challenges-of-medicaid-managed-care/. Last accessed February 25, 2015.
11 The government study examined Medicaid managed care programs in 33 states. Suzanne Murrin. “State Standard for Access to Care in Medicaid Managed Care.” Department of Health and Human Services, Deputy Inspector General for Evaluation and Inspections (September 2014). https://oig.hhs.gov/oei/reports/oei-02-11-00320.pdf. Last accessed February 25, 2015.
12 Robert Pear. “For Many New Medicaid Enrollees, Care Is Hard to Find, Report Says.” New York Times. (September 27, 2014). http://www.nytimes.com/2014/09/28/us/for-many-new-medicaid-enrollees-care-is-hard-to-find-report-says.html. Last accessed February 25, 2015.
13 Robert Pear. “For Many New Medicaid Enrollees, Care Is Hard to Find, Report Says.” New York Times. (September 27, 2014). http://www.nytimes.com/2014/09/28/us/for-many-new-medicaid-enrollees-care-is-hard-to-find-report-says.html. Last accessed February 25, 2015.