Medicaid’s Doctor Participation Rates

In seeking to repeal and replace the Affordable Care Act, Health and Human Services Secretary Tom Price has said “one out of every three physicians in this nation aren’t seeing Medicaid patients.” House Speaker Paul Ryan said “more and more doctors just won’t take Medicaid.”

It’s a common criticism of the Medicaid program — that the doctor participation rate is lower than the rate for Medicare beneficiaries or the privately insured. The implication is that Medicaid patients cannot access care and that it has gotten worse since the Affordable Care Act expanded the health care program for the low-income and disabled.

But experts say that implication is misleading:

• There are no continuous measures on Medicaid participation, but federal statistics gathered over recent years show that the percentage of physicians accepting new Medicaid patients has remained around 70 percent. We found no support for the idea that the participation rate has declined under the ACA.
• The participation rate varies by state, and it’s largely tied to reimbursement rates. For example, Montana pays primary care doctors the same rate for Medicaid and Medicare, and has a Medicaid doctor participation rate of 90 percent.
• Participation rates are limited measures of patient care. The supply of doctors and their geographic distribution are important factors — low rates in high population areas versus rural areas would have different impacts on patients.
• Studies show Medicaid beneficiaries fare as well as the privately insured on key measures of access to care. One analysis of federal survey data found that 74 percent of adults with Medicaid coverage had seen a doctor in the previous 12 months, while 69 percent with private insurance had done so.

The Statistics

The from the Centers for Disease Control and Prevention’s National Center for Health Statistics are for 2013, showing the percentage of physicians accepting new Medicaid patients was 68.9 percent, while 84.7 percent accepted new privately insured