More than half of the advertised health care providers were unavailable for Medicaid appointments when the Affordable Care Act opened the gates to nearly 10 million new enrollees in 2014.
“Notably, 51 percent of providers were either not participating in the plan at the location listed or not accepting new patients enrolled in the plan,” according to a recently-released report from the Department of Health and Human Services inspector general.
Even among those providers that could offer appointments for Medicaid patients, the median wait time was two weeks.
“When providers … cannot offer appointments, it may create a significant obstacle for an enrollee seeking care,” the IG said.
The report covered a period that ended in 2013. The report was released on Dec. 9 2014, then on Dec. 18, HHS officials announced there were 9.7 million new Medicaid enrollees in 2014 due to a provision in Obamacare that encourages states to expand eligibility for the program.
“The best news is that the number of people with health coverage continues to increase,” said Deputy Administrator of the Centers for Medicare and Medicaid Services Cindy Mann. “These individuals have gained access to quality health care services through these programs.”
Mann’s claim was directly contradicted by the earlier IG report.
“We found that people enrolled in Medicaid-managed care organizations may not be getting access to the care they need when they need it,” said a program analyst for the IG, Vince Greiber, in a companion podcast. “So, our work does raise questions about whether patients are getting treatment where and when they need it.”
In their response to the report, CMS officials pointed to other means of receiving care.
“While the provider directory is one resource used by enrollees, there are many other supports … such as managed care call centers, care coordinators, ombudsman offices and community health centers,” they said.
“Enrollees aren’t always cold calling doctors from a list,” said CMS spokesman Aaron Albright.
“Most beneficiaries have assigned primary care physicians who they can call for appointments; they do not search randomly in a directory,” he continued in an email.
However, CMS did contend to issues.
“Inaccurate provider directory data may unnecessarily delay an enrollee from selecting a provider,” the center said in the IG report.
Medicaid averaged about 57.8 million enrollees through most of the investigation, according to an enrollment report. As of December, there were 68.5 million enrollees.
Regardless, CMS’ press release was optimistic about the newly covered Americans.
“As we approach the New Year, we take time to reflect on the many individuals and families who have been helped by the Affordable Care Act,” Mann said.
Essentially, millions more people enrolling in Medicaid thanks to Obamacare, but the officials managing Obamacare are underestimating the number of available providers.
“[The investigation] suggests that the actual size of provider networks may be considerably smaller than what is presented by Medicaid managed plans,” the IG report said.
The IG report also raised questions about whether Medicaid enrollees would receive the benefits they were promised.
“These findings also raise serious questions about the abilities of plans, states and CMS to ensure that access-to-care standards are met,” the report said.
Albright cited that “a recent GAO report found that most beneficiaries who had Medicaid coverage for a full year did not report difficulty obtaining medical care, which was similar to individuals with full-year private insurance.”
The 2012 report also included data that states had difficulty ensuring there were enough Medicaid providers and that beneficiaries saw long wait times. It also underestimated that 7 million would enroll in 2014.
The IG report found similar data two years later.
Of the providers listed on the states’ directories, 8 percent were not accepting new patients, often because they already had too many.
More than one-third of health care providers were not at the location listed by the Medicaid plan. The remaining 8 percent were at the location, but were not part of the Medicaid plan.
In fact, investigators were told by some employees in doctors’ practices that they had never heard of the provider.
“Some providers had left months or even years before the time of the call,” the report said. “By continuing to inaccurately list these providers as participating, plans limit an enrollee’s ability to find a participating provider at a nearby location.”
Medicaid enrollees also faced long wait times before seeing a doctor. In addition to a two-week median wait, a quarter of providers had month-long backups.
In one example, an eight-week pregnant enrollee waited more than two months for an appointment with an obstetrician.
Specialists were more likely to schedule an appointment, but also usually had longer wait periods.
CMS agreed to follow the IG’s recommendations to make the states’ Medicaid plans more accurate and efficient.
