HHS OIG found that more than half of providers...could not offer appointments.
Patients in Medicaid may theoretically have access to care, but a new study found that they lack meaningful access due to low provider availability. The Department of Health and Human Services (HHS) studied provider availability in Medicaid managed care. The HHS Office of the Inspector General (OIG) conducted this study based on a congressional request to determine the adequacy of access to care.
HHS OIG found that more than half of providers that are meant to be available to managed care enrollees could not offer appointments. They determined that 35 percent were not at the location listed by the Medicaid managed care plan, eight percent were not participating in the plan, and eight percent were not accepting new patients. Where an appointment was available, the median wait time was two weeks, but over 25 percent had wait times of more than a month and 10 percent had wait times exceeding two months.
According to the New York Times, this study raises questions about whether new access to care gained under the Affordable Care Act (ACA) is meaningful. The ACA is fueling a rapid growth in Medicaid enrollment, with an addition nine million enrolled in the last year. The majority of these new enrollees are in Medicaid managed care plans, which are private health plans that use a network of doctors to manage care.
Given the results of this study, there are major implications for patient care. For example, a woman that is eight weeks pregnant may have to wait two months for an obstetrician. As a result, she will end up without any prenatal care during her first trimester of pregnancy. The ramification of a provider network more limited than it appears is that the health of enrollees may suffer.