Medicaid Enrollment Triggers Provider Access Issues

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Medicaid Enrollment Triggers Provider Access Issues
Calendar29 September 2014

Medicaid expansion under the ACA has been a key factor in the drop in the number of uninsured. But getting insurance is not the same thing as getting care, and a new report from HHS says that many Medicaid enrollees face either very long waits for appointments or must travel long distances to get to providers. Most states hire insurance companies to provide services to Medicaid enrollees through provider networks. While Federal rules say these plans must provide adequate access to all services covered, states can define what “adequate” means. According to the report, state standards for access to care vary widely, and HHS is calling for federal and state Medicaid officials to adopt stronger standards and do more to enforce them. Obama administration officials face similar issues as they set standards for health plans on the public exchanges. Employers can expect to feel the squeeze in their own health plans as primary care doctors take on more newly insured patients. The time is right to take another look at strategies to ease the strain, such as onsite clinics or telemedicine.

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