GAO: Of Medicaid beneficiaries surveyed, less than 4 percent have trouble receiving care


A new report from the Government Accountability Office (GAO) found that less than 4 percent of Medicaid beneficiaries who had coverage for at least a year reported difficulty obtaining medical care in 2008 and 2009, this despite more than two-thirds of states reporting they faced challenges in ensuring there are enough Medicaid providers to serve the growing number of beneficiaries.

Medicaid beneficiaries who had coverage for less than a year, however, were much more likely to have difficulty obtaining healthcare, and more than 5 percent reported difficulty in getting dental care. The Medicaid report released by GAO, which was provided to the U.S. Department of Health & Human Services, was intended to determine if states are providing adequate access to medical care to Medicaid recipients as enrollment has grown over the past few years, and is expected to grow by as many as 11 million as a result of health reform.

Thirty-eight of the 55 states and territories reported challenges in ensuring there were enough doctors participating in their program to ensure adequate delivery of care to Medicaid members.

“In general, states attributed these challenges to a shortage of providers and Medicaid payment rates, but also cited other issues, such as missed appointments and administrative burden, as factors that influenced provider participation,” the reported noted. “States reported efforts to simplify administrative processes to retain and attract Medicaid providers and, to a lesser extent, reported efforts to increase payment rates or other financial incentives.”

Providing dental care was the most common service area reported as being a challenge, cited by 30 of the states and territories. Twenty-six reported challenges providing specialty care for Medicaid patients, with 17 each saying alcohol and substance abuse care and primary care also presented challenges.

The research finding mirrors those of other published reports, the GAO said, which indicate that provider payment rates strongly influence decisions on whether to participate in the program. But, other studies have shown that while provider payment rates are a strong influence on the decision, it was not the sole driver of the decision.

“According to this study, other factors such as the structure of the practice and Medicaid administrative requirements can affect the decision to participate as well,” the report authors wrote.

Not surprisingly, then, 38 states also reported making payment or other administrative changes in their Medicaid programs in an effort to increase provider participation. The most common changes made, in addition to increased payments, were streamlined enrollment methods, increased speed in processing claims and reduced administrative burden for processing claims.

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