A new investigation and recently released report by the U.S. Department of Health and Human Services (DHHS) titled, Access to Care: Provider Availability in Medicaid Managed Care, shows that even of the Medicaid providers listed, nearly half are either not located where listed and unreachable, or are not accepting new Medicaid patients. Of those actually accepting and providing services to Medicaid patients, wait times to see a provider were often more than a month, and in some dire cases, more than two months.
The DHHS report, coupled with another report released several months ago titled, State Standards for Access to Care in Medicaid Managed Care, regarding provider density issues in various networks, are likely to generate a call for tougher standards on Medicaid health plans to reinforce and better document their provider networks. However, in areas of the country such as rural California, additional providers may simply be unavailable. Moreover, the studies did not compare satisfaction, accessibility, or patient wait times for appointments under the new managed care systems versus a more traditional fee-for-service Medicaid system. Outcomes may have been even worse without the shift to a more managed care approach.
California utilizes a 1 to 2000 Provider-to-Enrollee standard for the Medicaid program, with no standard for specialists. California also provides a standard for distance and time between enrollee’s residence and primary care providers, which is set at within 30 minutes or 10 miles, and no standard for specialists. It seems likely that in some rural areas of the state, this standard is likely not being met. Additionally, the State has a standard for access to an appointment time with primary care providers of within 10 days for routine care (15 days for seeing a specialist), and within 2 days for urgent care (4 days when waiting to see a specialist).
RCRC continues to be concerned about access to health care under the Affordable Care Act (ACA) in light of ongoing threats to providers and facilities from State sources, such as the Medi-Cal reimbursement rate cut, and periodic threats to the Medical Injury Compensation Reform Act (MICRA), which helps to maintain malpractice insurance rates in California at an affordable level for providers and health care facilities.
The Access to Care: Provider Availability in Medicaid Managed Care report can be accessed here. The State Standards for Access to Care in Medicaid Managed Care report can be accessed here.
