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The kids may not be alright

Medicaid and CHIP expansion may not result in greater access to primary care.

As implementation of the Patient Protection and continues, an estimated 7 to 12 million children will benefit from Medicaid and CHIP expansions. However, the question of access still remains. Will the number of newly insured children outpace the number of providers accepting public insurance? Will geographic disparities grow as some states opt out of expansion? Now that , what will happen to access for children?

Source: Flickr/CC

Source: Flickr/CC

A study published in Health Services Research this year examined the availability of primary care physicians that accept Medicaid or CHIP using data from the National Ambulatory Medical Care Survey (NAMCS) Electronic Health Records Survey.

Of 46 states examined, New Jersey had the lowest new Medicaid acceptance by primary care physicians, and Mississippi had the highest rate.

The investigators correlated states’ Medicaid/CHIP acceptance rates with access results and found more access problems (not accepting insurance or new patients) for Medicaid/CHIP patients than for privately insured patients. Other significant measures included lack of care in the last year due to long waits for appointments or long waiting times at offices. Furthermore, Medicaid/CHIP participants with special needs reported more problems with access compared to all Medicaid/CHIP participants.

There was a correlation between physician availability and access, but many questions are unanswered. States have different eligibility requirements for public insurance, making it difficult to draw clear conclusions. There was a significant difference in access for children with special needs, but there is no clear explanation for this difference as it was likely that offices were not aware of the child’s condition when contacted.

Additionally, access metrics are a moving target these days, so it is difficult to know how the status of Medicaid expansion compared between the two study years, the influence of temporary Medicaid parity to overall physician availability, and what the continued insurance enrollment will do for availability.

Overall, it’s all moving so fast that it’s a wonder patients can access anything.

commentary by Laura Grubb, MD, MPH, FAAP


OBJECTIVE: To estimate the relationship between physicians’ acceptance of new Medicaid patients and access to health care.

DATA SOURCES: The National Ambulatory Medical Care Survey (NAMCS) Electronic Health Records Survey and the National Health Interview Survey (NHIS) 2011/2012.

STUDY DESIGN: Linear probability models estimated the relationship between measures of experiences with physician availability among children on Medicaid or the Children’s Health Insurance Program (CHIP) from the NHIS and state-level estimates of the percent of primary care physicians accepting new Medicaid patients from the NAMCS, controlling for other factors.

PRINCIPAL FINDINGS: Nearly 16 percent of children with a significant health condition or development delay had a doctor’s office or clinic indicate that the child’s health insurance was not accepted in states with less than 60 percent of physicians accepting new Medicaid patients, compared to less than 4 percent in states with at least 75 percent of physicians accepting new Medicaid patients. Adjusted estimates and estimates for other measures of access to care were similar.

CONCLUSIONS: Measures of experiences with physician availability for children on Medicaid/CHIP were generally good, though better in states where more primary care physicians accepted new Medicaid patients. PMID: 25683869

Decker, SL. Health Serv Res. 2015 Oct;50(5):1508-27.

Laura K. Grubb, MD, MPH, FAAP
About Laura K. Grubb, MD, MPH, FAAP

Dr. Grubb is an adolescent medicine specialist and general pediatrician with research interests in health care reform implementation, single payer model realization in Vermont, and cost effectiveness of health care interventions. Dr. Grubb graduated cum laude with a BS in Biology from Georgetown University and received her MD from George Washington University. She completed pediatrics residency at the Naval Medical Center San Diego and is Board Certified in Pediatrics. She is a Fellow of the American Academy of Pediatrics. She served seven years in the Navy as a pediatrician and general medical officer. She completed her fellowship in Adolescent Medicine and an MPH (focusing on Health Systems Organization in the Management, Community Health, and Policy tract) at the University of Texas Health Sciences Center at Houston. She is currently an assistant professor of pediatrics at the Floating Hospital for Children at Tufts Medical Center in Boston. Contact: Website | Facebook | More Posts