As Medicaid enrollment grows, participating doctors decreases

As Medicaid enrollment continues to rise--it now covers as many as 1 in 5 Americans--the number of primary care physicians accepting Medicaid is dropping. Just 34 percent of PCPs now accept Medicaid, which is a 9-point drop from two years ago, according to a new HealthPocket report.

The decrease in PCP participation is largely because Medicaid pays doctors less than other insurers. Medicaid typically reimburses 61 percent of Medicare's payments for the same services. In contrast, Medicare generally pays about 80 percent of what private insurance companies reimburse.

"Consequently, in comparison to commercial health insurance from private insurance companies, Medicaid payments represent a reduction on a reduction," HealthPocket said in its report.

Although Medicaid temporarily increased payments to PCPs from 2013 to 2014, HealthPocket determined that the higher payments don't seem to have produced any lasting growth in PCP's Medicaid participation.

"The marked decline in Medicaid acceptance is significant," HealthPocket said, particularly since it comes when Medicaid is expanding so rapidly. Since the Affordable Care Act has led to widespread Medicaid expansion, enrollment grew by 16 percent, or 9 million beneficiaries, in expansion states from 2013 to 2014, FierceHealthPayer previously reported.

What's more, many Medicaid insurers' provider directories include doctors who are unavailable, not accepting new patients or could not be found. A federal watchdog determined that more than one-third of providers couldn't be found at their location listed by the insurer, and 50 percent of providers couldn't offer appointments to Medicaid members.

HealthPocket noted that Medicaid will need "a broader set of interventions" to ensure enough PCPs accept the insurance program.

To learn more:
- here's the HealthPocket report

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