Medicaid access to care Archives - Safety-Net Association of Pennsylvania

CMS Proposes Easing Medicaid Access Protections

States would have to do less to ensure access to Medicaid-covered services for their Medicaid population under a new regulation proposed by the Centers for Medicare & Medicaid Services.

In 2015, CMS required states to track their Medicaid fee-for-service payments and submit them to the federal government as part of a process to ensure that Medicaid payments were sufficient to ensure access to care for eligible individuals. Now, CMS proposes rescinding this requirement, writing in a news release that

This proposed rule is designed to help streamline federal oversight of access to care requirements that protect Medicaid beneficiaries. CMS anticipates that the proposed rule would, if finalized, result in overall cost savings for State partners that could be redirected to better serve the needs of their beneficiaries.

The proposed regulation itself explains that

While we believe the process described in the current regulatory text is a valuable tool for states to use to demonstrate the sufficiency of provider payment rates, we believe mandating states to collect the specific information as described excessively constrains state freedom to administer the program in the manner that is best for the state and Medicaid beneficiaries in the state.

CMS also notes that the current requirement applies only to Medicaid fee-for-service payments even though most Medicaid beneficiaries now receive care through managed care plans, the payments for which are not subject to the same process.

The agency adds that it intends to

…replace the ongoing access reviews required by current regulations with a more comprehensive and outcomes-driven approach to monitoring access across delivery systems, developed through workgroups and technical expert panels that include key State and federal stakeholders.

Because they care for so many Medicaid patients, the adequacy of the rates states pay for Medicaid services is especially important to Pennsylvania safety-net hospitals.

Learn more about CMS’s proposal in its news release on the subject or see the proposed regulation itself. Learn about the process CMS intends to employ to replace its current approach to monitoring access to Medicaid services in this CMS informational bulletin.

PA Safety Net Admin2019-07-18T06:00:42+00:00July 18th, 2019|Federal Medicaid issues|Comments Off

Docs Still Less Likely to Treat Medicaid Patients

Medicaid patients continue to be last in line when it comes to finding doctors willing to serve them.

At least that’s the conclusion drawn in a new analysis prepared by the Medicaid and CHIP Payment and Access Commission.

According to a presentation delivered at a MACPAC meeting last week:

Doctors are less likely to accept new Medicaid patients (70.8 percent) than they are patients insured by Medicare (85.3 percent) or private insurers (90 percent), with a much greater differential in acceptance rates among specialists and psychiatrists.
Pediatricians, general surgeons, and ob/gyns have a higher acceptance rate of Medicaid patients than physicians as a whole.
Physicians in states with high managed care penetration rates are less likely (66.7 percent) to accept Medicaid patients than physicians in states with low managed care penetration (78.5 percent).
There is no meaningful differential in acceptance rates among physicians in Medicaid expansion states and states that did not expand their Medicaid programs under the Affordable Care Act.
Physician acceptance rates have not changed since adoption of the Affordable Care Act in either Medicaid expansion nor non-Medicaid expansion states.
The higher the ratio of Medicaid-to-Medicare physician payments in an individual state, the more likely that physicians in those states will accept Medicaid patients. The difference is especially great among general practitioners and ob/gyns.

Learn more from the MACPAC presentation “Physician Acceptance of New Medicaid Patients.”

PA Safety Net Admin2019-01-31T06:00:14+00:00January 31st, 2019|Uncategorized|Comments Off

Medicaid Enrollees: Access and Quality Are Good

Medicaid beneficiaries are generally satisfied with their access to care and the quality of care they receive.
Or so reports a new study based on results of the federal Medicaid Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey for December of 2014 to July of 2015.
According to the survey, nearly half of Medicaid patients rated their overall care 7.9 or greater on a scale of 10; 84 percent reported that they had been able to receive all of the care they needed over the past six months; and most were generally satisfied with the coverage. Relatively few reported problems finding providers willing to accept their Medicaid coverage.
Survey results generally were slightly more positive in Medicaid expansion states than in non-expansion states.
Pennsylvania safety-net hospitals serve especially large numbers of Medicaid patients.
Learn more about how Medicaid beneficiaries view the quality and accessibility of the care they receive in the JAMA Internal Medicine report “What Enrollees Think of Medicaid | Health Care Reform,” which can be found here.

PA Safety Net Admin2017-07-12T14:02:19+00:00July 12th, 2017|Pennsylvania safety-net hospitals|Comments Off

CMS Requires States to Monitor Medicaid Access

A new federal regulation requires states to monitor access to Medicaid-covered services.
According to a new regulation issued by the Centers for Medicare & Medicaid Services (CMS), states must submit to CMS plans for monitoring Medicaid beneficiary access to care in five service areas: primary care, physician specialists, behavioral care; pre- and post-natal care; and home health services.
State monitoring plans must address the extent to which Medicaid is meeting beneficiaries’ needs; the availability of care; changes in service utilization; and comparisons between Medicaid rates and rates paid by other public and private payers.
Interested parties have 60 days to submit comments to CMS about the new regulation.
For a closer look at the regulation, see this CMS fact sheet and the regulation itself here, in the Federal Register.

PA Safety Net Admin2015-11-12T12:09:56+00:00November 12th, 2015|Uncategorized|Comments Off

But Does Coverage Mean Access?

More than 12 million people have joined the Medicaid rolls in the U.S. since the Affordable Care Act’s voluntary expansion of Medicaid eligibility began in January of 2014.
Historically, however, many Medicaid patients have had a difficult time finding doctors willing to serve them because in many states, Medicaid payments are so low that doctors choose not to participate in the program.
Is that still the case today? What challenges do Medicaid patients face when they need medical care?
In a new article titled “You’ve Got Medicaid – Why Can’t You See the Doctor?”, U.S. News & World Report takes a look at this issue. Find its report here.

PA Safety Net Admin2015-06-03T06:00:53+00:00June 3rd, 2015|Affordable Care Act|Comments Off

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