When a Medicaid Card Isn’t Enough

Much of the discussion surrounding Medicaid focuses on expansion. However, is there enough being done to ensure care is accessible once people are enrolled? In Tradeoffs, Paul Shafer, argues that network adequacy standards for Medicaid plans are failing to ensure availability of providers. Access to care is limited for Medicaid enrollees in part because Medicare and private insurers provide physicians with higher payment rates. Shafer writes,

A new paper in Health Affairs by Avital Ludomirsky and colleagues looked at how well the networks of physicians supposedly participating in Medicaid reflect access to care. The researchers used claims data and provider directories from Medicaid managed care plans in Kansas, Louisiana, Michigan and Tennessee from 2015 and 2017 to assess how the delivery of care to Medicaid patients was distributed among participating doctors. Their results were striking: 

  • One-quarter of primary care physicians provided 86% of the care; one-quarter of specialists provided 75%. 

  • One-third of both types of physicians saw fewer than 10 Medicaid patients per year, hardly contributing any “access” at all. 

  • There was only one psychiatrist for every 8,834 Medicaid enrollees after excluding those seeing fewer than 10 Medicaid patients per year. This is especially concerning given that the COVID-19 pandemic has worsened mental health in the U.S., particularly among children. 

Read the full piece here!

Research for this piece was supported by Arnold Ventures.

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