In the past year, the Patient Protection and Affordable Care Act has spurred a 16 percent increase in Medicaid enrollment, yet federal investigators found more than half of physicians listed as Medicaid providers are not available to treat enrollees, according to the The New York Times.
A report was issued Tuesday from inspector general Daniel R. Levinson after investigators from the Department of Health and Human Services called 1,800 providers listed in more than 200 plans under contract with Medicaid in 32 states, according to The New York Times. They found less than half of primary care providers were able to offer a new patient an appointment, among other findings.
"When providers listed as participating in a plan cannot offer appointments, it may create a significant obstacle for an enrollee seeking care," Mr. Levinson told The New York Times. "Moreover, it raises questions about the adequacy of provider networks. It suggests that the actual size of provider networks may be considerably smaller than what is presented by Medicaid managed-care plans."
Investigators discovered the following:
- 35 percent of providers were not at the location listed by a Medicaid managed-care plan, and in some cases the practices had never heard of the provider or the provider left the practice months or years ago.
- 8 percent of providers reported they were not participating in the listed Medicaid managed-care plan.
- 8 percent were not accepting new patients enrolled in the plan.
- 28 percent of providers who offered appointments had wait times longer than one month.
- 10 percent of providers had wait times longer than two months.
- The median wait time was 2 weeks.
- 44 percent of primary care providers were able to offer a new patient an appointment.
- 57 percent of specialists were able to offer a new patient an appointment.
- The median wait time for specialists was twice as long for specialists than primary care providers (20 days compared to 10 days).
- 34 percent of specialists who offered new patients appointments had wait times longer than one month.
- 11 percent of specialists had wait times longer than 2 months.
New standards are being developed to ensure timely access to care for Medicaid patients, James Golden, director of managed-care plans at the federal Medicaid agency, told The New York Times. State standards for access to care and enforcement of standards vary widely, according to the report.
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