Patient Experience Of Provider Refusal Of Medicaid Coverage And Its Implications

Abstract

Previous studies show that many physicians do not accept new patients with Medicaid coverage, but no study has examined Medicaid enrollees' actual experience of provider refusal of their coverage and its implications. Using the 2012 National Health Interview Survey, we estimate provider refusal of health insurance coverage reported by 23,992 adults with continuous coverage for the past 12 months. We find that among Medicaid enrollees, 6.73% reported their coverage being refused by a provider in 2012, a rate higher than that in Medicare and private insurance by 4.07 (p<.01) and 3.68 (p<.001) percentage points, respectively. Refusal of Medicaid coverage is associated with delaying needed care, using emergency room (ER) as a usual source of care, and perceiving current coverage as worse than last year. In view of the Affordable Care Act's (ACA) Medicaid expansion, future studies should continue monitoring enrollees' experience of coverage refusal.

Neighborhood Deprivation and Childhood Asthma Outcomes, Accounting for Insurance Coverage

“…Although we did not collect neighborhood contextual factors, we can speculate about factors explaining differences in outcomes based on insurance coverage, such as lower access to continuous care, because lower public insurance reimbursement to providers may contribute to outpatient clinics limiting or refusing publicly insured patients, thus hampering a child' s ability to receive early and comprehensive care and increasing the risk of having poor asthma control and exacerbations. 41,42 Public insurance recipients are also often financially challenged and have limited education, both of which contribute to low adherence to treatment, and are more likely to live in environments with increased exposure to asthma triggers, making asthma exacerbations more common. 43 Overall, poor outcomes among patients with public insurance may highlight the unmet health care needs of recipients, including limited access to outpatient services and asthma medications.…”

State Variation in Medicaid Reimbursements for Orthopaedic Surgery

“…Prior qualitative studies have indicated that the most cited reason for physicians to not participate in Medicaid was inadequate reimbursement 4 , with frustration among the orthopaedic community in caring for a "challenging, high-risk, and under-insured population while also assuming additional liability without adequate compensation." 5 The shortage of orthopaedic surgeons participating in Medicaid may have dire implications on community health 6,7 and may increase socioeconomic disparities in delivery of orthopaedic care [8][9][10] . Thus, increases in provider reimbursement are often discussed as a potential policy lever to increase access to care for patients with Medicaid [11][12][13] .…”

Differential effects of the Affordable Care Act on the stage at presentation and receipt of treatment for pancreatic adenocarcinoma

“…Additionally, barriers to obtaining health insurance despite national policy change and barriers to obtaining care despite obtaining public health insurance require attention. These barriers emerge from both the patient perspective such as lack of education and awareness as well as from a socioeconomic and system level, such as the inability to take time off work or the refusal by providers to accept new Medicaid‐insured patients 32,33 . An optimistic example can be seen in safety‐net settings where vulnerable patients represent a higher proportion of patients.…”