Medicaid Provider Figures Don’t Reflect Reality of Patient Care
by J. Bendix;; 12/12/14

More than half from the physicians around the world who supposedly treat Medicaid patients don’t actually do so, a whole new government report finds.

Approximately 49 million Americans obtain healthcare services beneath the Medicaid program, and many of those services are given through Medicaid managed care organizations (MCOs).

But as outlined by a report prepared by the Office with the Inspector General (OIG) in the U.S. Department of Health and Human Services, 43% of providers listed by MCOs as accepting Medicaid patients either weren't practicing in the location where we were holding listed or weren't participating in the MCO, and another 8% were not accepting new patients going to the plan.

“When providers listed as participating in a plan cannot offer appointments, it may create a tremendous obstacle for an enrollee seeking care,” the report notes. “Moreover, it suggests that the actual sized provider networks may be considerably smaller than is presented by Medicaid managed care plans. It also raises questions about whether these plans are complying with their states’ standards for access to care.”

Under the Affordable Care Act, states have the option of expanding Medicaid eligibility to include families earning as much as 138% of the federal poverty level, using the additional costs covered entirely from the federal government for the first four years and at 90% thereafter.

To-date 27 states along with the District of Columbia have expanded Medicaid eligibility, and also the Congressional Budget Office estimates the number of people covered by Medicaid will increase to 87 million by 2018. The OIG report thus may raise doubts concerning Medicaid’s ability to deliver healthcare services to new enrollees in a meaningful way.

Other findings in the report:

Among the 49% of providers who did offer appointments, the median wait time was two weeks, but more than 25% had wait times of over one month,

Specialists were prone to provide appointments than primary care providers (57% versus 44%),

Yhe median wait time for the specialist appointment was 20 days, versus 10 days for any primary care provider

The report recommends how the Centers for Medicare and Medicaid Services work with states to:

Assess the number of network providers and increase the accuracy of plan information, ensure that MCO networks meet the needs with their enrollees, and ensure that plans are complying with existing state standards and assess whether additional standards are essential.

Results of the study were determined by telephone calls to a random sample of primary care providers and specialists from July through October, 2013.




“Under the care of Leo J. Borrell, M.D. since December 2001, I have seen a remarkable improvement in my mother’s condition. She is responding dramatically to the new regiment Dr. Borrell has prescribed”

- Beth Rose


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