July 25, 2007
Got Medicaid? The Doctor Might Not See You
Last week the Wall Street Journal (subscription req'd) published an article explaining how more and more doctors are no longer accepting Medicaid.
Here are a few excerpts:
In a 2006 report from the Center for Studying Health System Change, a nonprofit research group based in Washington, nearly half of all doctors polled said they had stopped accepting or limited the number of new Medicaid patients.
That’s because many Medicaid programs, straining under surging costs, are balancing their budgets by freezing or reducing payments to doctors. That in turn is driving many doctors, particularly specialists, out of the program.
In Michigan, the number of doctors who will see Medicaid patients has fallen from 88% in 1999 to 64% in 2005. Many of those doctors tightly cap how many they’ll see or refuse to take on new Medicaid patients. At the same time, enrollment in the program in Michigan has risen more than 50% to nearly 1.6 million since 1999.
“At this point, I have to pay money out of my own pocket to take care of that [Medicaid] patient, and it’s only going to get worse,” says AppaRao Mukkamala, president of the Michigan State Medical Society and a radiologist in Flint, Mich. There, auto-industry layoffs have helped push one in five people onto Medicaid or into the ranks of the uninsured.
For every chest X-ray Dr. Mukkamala performs, for instance, Medicaid pays him $20. Commercial insurers such as Blue Cross pay about $33 and Medicare pays $30. But with technicians, film and other equipment, his costs are about $29 per X-ray, he estimates. Medicaid patients he sees at Hurley Medical Center in Flint make up 28% of his work there.
Higher costs are forcing state Medicaid programs to cut reimbursement rates. These lower rates force care providers to accept a lower percentage of Medicaid patients. In some cases, the providers move out of the area completely. This leaves Medicaid patients with access to care issues.
In Benton Harbor, more than 300 patients lost access to counseling services after the main provider of Medicaid mental-health services, Riverwood Center, stopped accepting payments from Medicaid HMOs. Riverwood says the reimbursements it was receiving from the Medicaid HMOs for outpatient sessions didn’t cover their costs.
As the city’s middle class dwindled, most doctors, along with the hospital, relocated in the late 1980s and early 1990s across the St. Joseph River to its much more affluent twin, St. Joseph, a picturesque lake-resort town. Most of those doctors are listed in HMO networks but many don’t accept Medicaid patients in their offices. Instead, many spend an afternoon every one or two weeks seeing Medicaid patients at a clinic set up in a building that once housed Benton Harbor’s hospital.