• Medicaid access ain’t so bad

    The GAO did a study:

    Medicaid enrollment has grown significantly in recent years due to the economic downturn. This growth is expected to continue as the Patient Protection and Affordable Care Act potentially extends Medicaid eligibility in 2014 to millions of uninsured individuals. To better understand whether states are providing adequate access to medical care for beneficiaries, this report examines (1) states’ experiences processing Medicaid applications, (2) states’ changes to beneficiary services and provider payment rates, (3) the challenges states report to ensure sufficient provider participation, and (4) the extent to which Medicaid beneficiaries reported difficulties obtaining medical care. To examine the first three objectives, GAO administered a nationwide web-based survey to Medicaid officials on states’ experiences from 2008 through 2011 and obtained a response rate of 98 percent. To examine the last objective, GAO analyzed data from the 2008 and 2009 Medical Expenditure Panel Survey, the most current available at the time of our analysis, to assess Medicaid beneficiaries’ reported difficulties obtaining care, and the 2009 National Health Interview Survey to assess their reasons for delaying care. To provide context, we compared their experiences to those of individuals with private insurance or who were uninsured.

    Basically, they looked at how states process Medicaid applications, how they have changed their programs, what barriers exist preventing full enrollment, and how often those who get Medicaid say they have trouble getting care. You know, the stuff some people like to say Medicaid is terrible at.

    What did they find?

    States reported making numerous changes to provider payments, provider taxes, and beneficiary services since 2008. While more states reported provider-rate and supplemental payment increases each year from 2008 through 2011, the number reporting payment reductions and increased provider taxes also grew. More states reported increasing services than limiting them.

    And what about access?

    In calendar years 2008 and 2009, less than 4 percent of beneficiaries who had Medicaid coverage for a full year reported difficulty obtaining medical care, which was similar to individuals with full-year private insurance; however, more Medicaid beneficiaries reported difficulty obtaining dental care than those with private insurance. Beneficiaries with less than a full year of Medicaid coverage were almost twice as likely to report difficulties obtaining medical care as those with full-year coverage. Medicaid beneficiaries reported delaying care for reasons such as long wait times and lack of transportation.

    Not that I expect any of this will be reported widely. Full report here.

    • My corporation has changed insurers almost every year to avoid large premium changes. What we have seen over the last 20 years is that it takes a while for people to accommodate to the new health plan. People are slow to use the new plan until they figure it out. Sounds about the same for Medicaid. One reason, among many, that I am not impressed by some studies showing cost savings in a first year change to a new kind of coverage.

      As an aside, a 98% response rate is awesome.


    • If you dig further down into the report, you’ll find another chart showing that this level of access is markedly different between children and working-age adults. For the latter group, which includes the disabled, access is worse than in private insurance.

    • Hey Aaron,

      Wanted to let you know that I saw this post on Friday, and that ThinkProgress Health actually did report on this: http://thinkprogress.org/health/2012/11/16/1206871/study-americans-happy-medicaid/

      So maybe not “widely reported,” but alongside yours, there’s at least two posts out there…