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For Medicaid enrollees, is access an issue?

How tough is it for Marylanders insured by Medicaid to find a doctor? What about residents of other states?

Those are the questions federal officials hope to answer with a survey, beginning this fall, of about 1.5 million adult Medicaid enrollees across the country.

The Federal Centers for Medicare and Medicaid Services (CMS) will ask about 29,000 enrollees from each state about their experiences, particularly whether they’re able to find health care providers who accept Medicaid (the federal health insurance program for poor or disabled people), as well as the quality of those providers.

What they find might be hard to swallow, according to a recent article in Modern Healthcare.

“The CMS should brace itself for some bad news in terms of access to medical treatment for beneficiaries, though some bright spots exist,” writes Virgil Dickson for Modern Healthcare.

The goal is to then use the data collected to make whatever improvements to Medicaid might be necessary.

It is widely acknowledged that Medicaid-accepting providers can be difficult to find. Many physicians decline to accept Medicaid because the program’s reimbursement rates tend to be lower than the rates paid by Medicare and by commercial insurance carriers.

[Side note: In the middle of writing this blog, I got a call from a friend who enrolled in Medicaid this year. She was having trouble finding a specialist and asked for help. No joke — this really happened.]

Additionally, some people have the perception that providers who accept Medicaid are not of top-notch quality.

The survey is well-timed: Maryland is one of 26 states (and Washington D.C.) that opted to expand Medicaid eligibility this year. In this state, more than 300,000 people have joined the Medicaid rolls since October.

The survey will also seek to flesh out whether there are differences in the experiences of people enrolled in Medicaid managed-care organizations versus those who see fee-for-service providers.

That, too, is well-timed. Nationwide, there’s a “steady migration” of Medicaid beneficiaries switching from fee-for-service providers to managed-care organizations — a model that requires states to pay capitated rates to another entity, like an insurance carrier, to oversee all the health needs of people in the program.

According to Modern Healthcare, CMS is likely to find “a mixed picture overshadowed by general concerns that reimbursement rates remain too low to entice many doctors to accept new Medicaid patients.”

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