Trends in Physician Participation in Medicaid
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Physician participation rates in Medicaid vary widely across the country, and, overall, there has been a decline in recent years. We performed an evaluation in California of whether the expansion of Medicaid managed care and a physician payment increase were associated with an increase over time in the percentage of physicians caring for Medicaid patients. Surveys performed before and after these strategies were used did not reveal an increase over time in physicians' participation in California's Medicaid program. Budgetary constraints will force policy makers to confront the priorities of the Medicaid program, to question the policy objectives for physician participation in Medicaid, and to consider more far-reaching reforms in Medicaid and the overall health care system.Keywords:
Health reform
Part of a symposium issue on the impact of federal health reform, this article argues that the expansion of Medicaid under the Affordable Care Act will eliminate the historical use of the Medicaid program to try to differentiate the “deserving” from the “undeserving” among low-income individuals and makes access to this form of health insurance available to a greater proportion of low-income individuals primarily on the basis of economic need. The article also identifies remaining challenges to the efficacy of this revised Medicaid program.
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A new Medicaid Analytic eXtract (MAX) chartbook summarizes the Medicaid program and the MAX data system. Developed for state Medicaid directors, policymakers, researchers, and others interested in the Medicaid program, the chartbook is a research tool and reference guide on Medicaid enrollees and their Medicaid experiences in 2008. It consists of illustrative graphs, descriptive text, and an extensive data appendix with summary national- and state-level information on enrollees' demographic and eligibility characteristics, Medicaid service use, and Medicaid expenditures in 2008, as well as trends in key enrollment and utilization patterns over time.
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A new Medicaid Analytic eXtract (MAX) chartbook summarizes the Medicaid program and the MAX data system. Developed for state Medicaid directors, policymakers, researchers, and others interested in the Medicaid program, the chartbook is a research tool and reference guide on Medicaid enrollees and their Medicaid experiences in 2008. It consists of illustrative graphs, descriptive text, and an extensive data appendix with summary national- and state-level information on enrollees' demographic and eligibility characteristics, Medicaid service use, and Medicaid expenditures in 2008, as well as trends in key enrollment and utilization patterns over time.
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Medicaid coverage matters for millions of low-income Americans, and especially for those with ongoing and serious health challenges. A source of comprehensive and affordable coverage, Medicaid has long been a cornerstone of federal and state efforts to improve access and health outcomes for very poor and medically vulnerable populations. The Affordable Care Act (ACA) leveraged Medicaid's role in serving the poor to broaden the program's reach to millions of low-income uninsured adults, and positioned the program as a fundamental component of the newly established continuum of public and private coverage. Looking ahead, if more states embrace the Medicaid expansion, there is the potential to build on this progress to significantly reduce the number of uninsured Americans.
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To identify ICD-10-CM diagnostic codes associated with the social determinants of health (SDOH), determine frequency of use of the code for homelessness across time, and examine the frequency of interrupted periods of Medicaid eligibility (ie, Medicaid churn) for beneficiaries with and without this code.Retrospective data analyses of New York State (NYS) Medicaid claims data for years 2006-2017 to determine reliable indicators of SDOH hypothesized to affect Medicaid churn, and for years 2016-2017 to examine frequency of Medicaid churn among patients with and without an indicator for homelessness.Any interruption in the eligibility for Medicaid insurance (Medicaid churn), assessed via client identification numbers (CIN) for continuity.Analyses were conducted to assess the frequency of use and pattern of New York State Medicaid claims submission for SDOH codes. Analyses were conducted for Medicaid claims submitted for years 2016-2017 for Medicaid patients with and without a homeless code (ie, ICD-10-CM Z59.0) in 2017.ICD-9-CM / ICD-10-CM codes for lack of housing / homelessness demonstrated linear reliability over time (ie, for years 2006-2017) with increased usage. In 2016-2017, 22.9% of New York Medicaid patients with a homelessness code in 2017 experienced at least one interruption of Medicaid eligibility, while 18.8% of Medicaid patients without a homelessness code experienced Medicaid churn.Medicaid policies would do well to take into consideration the barriers to continued enrollment for the Medicaid population. Measures ought to be enacted to reduce Medicaid churn, especially for individuals experiencing homelessness.
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Prologue: Medicaid is a major culprit in rising health care costs. The program s expenditures increased by 13 percent in 1989, 18 percent in 1990, 27 percent in 1991, and 30 percent in 1992 to reach $120 billion. Medicaid has often crowded out other items in states' budgets; New York, for example, has decreased its public education spending by 5 percent in the past two years. The Kaiser Commission on the Future of Medicaid has attributed Medicaid's rising costs to increased enrollment in the program (the costliest portion being additional elderly and disabled beneficiaries), increased medical costs in general, and a higher outlay per beneficiary, reflecting both a sicker population and efforts to keep up with private payers' reimbursement rates. Any health care reform proposal will clearly need to address this cost crisis. Yet author James Fossett argues in this paper that “the largest and most rapidly growing parts of Medicaid are outside the jurisdiction of most currently discussed health reform plans.” Using New York as a case study, he shows that the practice of shifting various state programs onto Medicaid to receive matching federal dollars has resulted in a category of “Medicaided” programs beyond the scope of health care reform. Also, approximately 30 percent of Medicaid spending goes to elderly beneficiaries' long-term care, which is not included in most health care reform proposals. Yet these are costly aspects of the Medicaid program. “The forces that have caused rapid Medicaid growth in New York and similar states are not the same as those that have produced rapid growth in total health expenditures,” warns Fossett. Medicaid requires a separate reform effort. Fossett is an associate professor at the State University of New York's Graduate School of Public Affairs and School of Public Health in Albany. He holds a doctorate in political science from the University of Michigan. Abstract: New York State has the largest, most expensive state Medicaid program in the country. Thus, an examination of its Medicaid program can offer valuable lessons for other states that are considering reform of their health systems, as well as for reform at a nationwide level. Much recent growth in Medicaid in New York stems from shifting state-funded human service programs onto Medicaid and shifting the state's share of Medicaid onto nontraditional revenue sources. In contrast to other states, in which Medicaid is an unpopular program, New York's Medicaid provider constituency is large and diverse, and its clientele is relatively white and middle class. These two constituencies have made Medicaid harder to cut than in other states, in which Medicaid recipients lack political and economic clout. Current versions of national health reform will have little effect on Medicaid spending in New York, since they address neither spending on the elderly nor the “Medicaiding” of programs and revenue sources.
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The recently passed U.S. health care reform law envisions a health care system that rests atop a four-legged stool consisting of employer-sponsored health plans, coverage purchased through state-based exchanges, Medicare, and Medicaid. Each leg faces important challenges, none more than Medicaid. Numerous issues confront the "new" Medicaid. Will states be able to achieve full coverage for eligible persons and align their operations smoothly with those of other coverage sources? Will coverage be adequate to the population's need? Will providers participate, and will the safety net be sustained? And perhaps above all, will states continue to operate Medicaid programs and share . . .
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Abstract Objective To quantify impacts of early Affordable Care Act (ACA) Medicaid expansions on Medicaid participation for primary care physicians. Data Sources The study uses secondary Medicaid Analytic eXtract (MAX) data from the United States for 2009–2012, as well as secondary National Plan and Provider Enumeration System (NPPES) data from the United States for 2015. Study Design The study uses a quasi‐experimental difference‐in‐differences study design where the policy change is Medicaid expansion in six states that adopted early ACA Medicaid expansions during 2010 and 2011: California, Connecticut, the District of Columbia, Minnesota, New Jersey, and Washington. The key outcome variables are five monthly measures of physician participation: the number of Medicaid visits, the number of Medicaid patients, seeing at least 1 Medicaid patient, seeing at least 25 Medicaid patients, and seeing at least 50 Medicaid patients. Data Collection/Extraction Methods The sample consists of all physicians who were active between 2005 and 2015, according to the NPPES. Principal Findings For primary care physicians, Medicaid expansion led to a 29% increase in Medicaid visits (5.88 per month; 95% CI: 2.49–9.27), a 29% increase in Medicaid patients (4.59 per month; 95% CI: 2.16–7.02), and did not affect the probability of any Medicaid participation. Medicaid expansion also led to a 22% increase in the probability of seeing at least 25 Medicaid patients per month (4.58 percentage points; 95% CI: 1.27–7.89) and a 31% increase in the probability of seeing at least 50 Medicaid patients per month (2.99 percentage points; 95% CI: 0.99–4.99). Conclusions Early ACA Medicaid expansions led to increased Medicaid visits for primary care physicians but did not affect the probability of any Medicaid participation. Primary care physicians who had previously served Medicaid patients responded to early ACA Medicaid expansions by serving substantially more Medicaid patients.
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The Supplemental Security Income (SSI) program for children and adolescents has experienced a fourfold enrollment growth since 1989. Most SSI recipients also receive Medicaid, and SSI growth could therefore lead to major new Medicaid expenditures if new SSI recipients were not previous Medicaid enrollees. Using Medicaid claims for 1989-92, we determined whether SSI expansions included many children new to Medicaid as well as whether children with certain disabilities were more likely to have had Medicaid prior to SSI enrollment. Rates of new SSI enrollees without previous Medicaid coverage decreased from 53 percent in 1989 to 39 percent by 1992.
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In Reply.
—The data from Dr Fox and Mr Phua are of interest because they reflect the effects of actual increases in Medicaid payments on obstetricians' participation in Medicaid. Although the increase in payments stemmed declining participation rates, they found, as we did, that the overall effect of increased payments on participation was modest. The second North Carolina Pediatric Society survey points up how different approaches to measuring participation in Medicaid may yield different results. This survey differed somewhat from ours in that it was sent only to pediatricians who were members of the pediatric society, a different definition was used to determine if pediatricians were in active practice, the findings regarding the relationship of Medicaid payments to participation were not controlled for other factors that may influence physicians' decisions to participate in Medicaid, and the survey asked what physicians would do in response to increased payments rather than assessingCite
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