Medicaid Participation Among Urban Primary Care Physicians

Abstract

Strategies other than raising Medicaid payment levels will be needed to achieve equitable access to office-based primary care for the poor residing in cities.

The Impact of Health Reform on Purchased Care Access: National Health Reform and Modernization of the Military Health System Study

“…Indeed, data show that despite increases in both Medicaid payment rates and its enrollment over the previous decade and some evidence on increased access to care (Baker and Royalty, 1997;Garthwaite, 2012), the share of physicians accepting Medicaid patients had decreased (Cunningham and May, 2006). 1 Several studies have shown, however, that low or nonparticipation rates varied spatially, as they are associated with such factors as the size of the Medicaideligible population in the geographic area (Mitchell, 1991) and other community-level characteristics, such as income per capita (Perloff et al, 1997).…”

Cost and Reimbursement as Determinants of the Quality of Diabetes Care: 3. Reimbursement Determinants

“…In addition, many insurers, including Medicare, audit the frequency with which individual providers bill at a high level of service (Levels 4 and 5). Providers who "fall out" by computer urban primary care physicians 9 found that the majority did not participate in Medicaid at all, or restricted acceptance of Medicaid patients in New York. These sorts of cost issues would be expected to affect diabetic patients.…”

Medicaid Policy Statement

“…In general, pediatricians serve more Medicaid patients than do other primary care physicians. 6,7 On average, 30% of a pediatrician's patients are covered by Medicaid, 8 illustrating the commitment of pediatricians to ensure that Medicaid-insured children have access to a medical home. 9 The 1990s brought significant progress in expanding health care coverage for children younger than 21 years through Medicaid expansions and the creation of the State Children's Health Insurance Program (SCHIP).…”