No “Room” In Many Practices For New Medicaid Patients

By  //  August 11, 2012

Healthcare Resources

EDITOR’S NOTE: It is projected that the Medicaid expansion provided for in the Patient Protection and Affordable Care Act (PPACA) will add up to 16 million new Medicaid enrollees to the already 60 million people presently on Medicaid.  Finding the “willing” professional resources, especially primary care, to incorporate new Medicaid patients into their practice is clearly recognized across the healthcare industry as a major challenge and threat to one of the core PPACA aims–to meet the healthcare needs of more Americans.  Unfortunately, the law provides for increasing health insurance coverage of more American lives, but does not ensure that those added to the Medicaid rolls, or those already on Medicaid for that matter, will have available to them the professional resources they need.

Access to physicians for Medicaid patients is particularly challenging because of the historically very poor pay associated with Medicaid coverage, administrative hassles and delays in getting paid.

Although the PPACA includes numerous provisions intended to increase the primary care and public health workforce, the “elephant in the room” that seems to be overlooked is the fact that a significant segment of the existing primary care workforce limits or does not accept Medicaid patients in their practices.

Excerpted below, Kaiser Health News (KHN) reports on a Centers for Disease Control CDC) study published earlier this week in the journal, Health Affairs, which uses data on office-based physicians from the 2011 National Ambulatory Medical Care Survey Electronic Medical Records Supplement to summarize the percentage of physicians currently accepting different categories of new patients.

Access to physicians for Medicaid patients is particularly challenging because of the historically very poor pay associated with Medicaid coverage, administrative hassles and delays in getting paid. The percentage on average of U.S. office-based physicians accepting new Medicaid patients in 2011 was 69.4%, with Florida below that at  59.1% (over one out of three do not take new Medicaid patients; see national table in the KHN report below).

That percentage is much lower here on the Space Coast. In a random phone survey of office-based primary care physician practices in Brevard County done by, only 2 out of the 40 (5%) primary care physicians contacted presently accept new Medicaid patients.

To address the low Medicaid physician pay scale and incentivize physicians to participate, there are provisions in the PPACA that increase pay in 2013 and 2014  for primary care physicians who treat Medicaid patients.  The initial 30% hike on average nationally may increase participation and acceptance of new Medicaid patients, but many physicians have reservations related to what may happen after 2014 when they’ve taken on the responsibility of new lives.  The concern is that in 2015 when the provision for the federally funded pay rate increase in the PPACA expires, Congress may come under pressure to continue the funding, but has no statutory obligation and may not extend the increase.

A very important alternative to private primary care as first-line professional resources for Medicaid recipients is community health centers like Brevard Health Alliance. The PPACA provides $11 billion to expand community health centers that provide primary care to Medicaid patients.

It is clear that long term solutions to meeting the healthcare needs of more Americans will require changing attitudes on the part of all stakeholders, and a transformational redesign of care and payment models to ensure the appropriate level of care at an affordable price. However, whether or not the PPACA, which promises to create an explosion of publicly insured people at reimbursement levels that are well below the cost of providing services, can provide those solutions remains to be seen.

KAISERHEALTHNEWS.ORG–If you’re on Medicaid and looking for a new doctor, your chances are excellent of finding one … in Wyoming.

In New Jersey, not so much.

About 69 percent of doctors nationally accept new Medicaid patients, but the rate varies widely across the country, according to a study published Monday in the journal Health Affairs.

New Jersey had the nation’s lowest rate at 40 percent, while Wyoming had the highest, at 99 percent, according to a survey last year of doctors by the U.S. Centers for Disease Control and Prevention.

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