Medicaid beneficiaries have same care access as the privately insured?
By Vanessa De La Rosa
A new study comparing Mecidaid and private insurance conducted by the Government Accountability Office reveals some surprising and not-so-surprising findings about Medicaid and states’ abilities to provide adequate access to medical care for its beneficiaries. The study’s four objectives are listed below, followed by the corresponding results.
(The first three objectives and their conclusions are based on a nationwide Web-based survey than spanned the years 2008 to 2011 and was sent to Medicaid officials.)
1. To examine states’ experiences processing Medicaid applications. Over the period from 2008 to 2011, over half of the states reported upholding or reducing average application processing times, “the average number of calendar days between the receipt of a new application and the final determination of eligibility.” Thirty-nine states reported that their average application processing times fell within a range of 11 to 45 calendar days. The decrease in application times were attributed to several streamlining procedures, like electronic applications and the elimination of face-to-face interview requirements.
However, the study notes, “because of data limitations, we were unable to assess the extent to which the number of applications processed kept pace with the number of new applications received each month … most states provided incomplete or inconsistent data on new applications received and processed.” 2. To examine states’ changes to beneficiary services and provider payment rates. States reported making numerous changes to beneficiary services and provider payment rates. For each year from 2008 to 2011, more states reported provider-rate and supplemental payment increases. However, the number of states that reported payment reductions and increased provider taxes also rose. Overall, more states reported an increase in services than a decrease.
3. To examine the challenges states report when ensuring sufficient provider participation. Certain challenges — namely, Medicaid payment rates and a shortage of providers — were reportedly faced by over two-thirds of states. Over half of the states say they simplified administrative requirements of increased payment rates to attract new providers, including dental and specialty care providers.
For the last objective, the GAO analyzed research from two surveys: the 2008 and 2009 Medical Expenditure Panel Survey to examine reported difficulties faced by Medicaid beneficiaries when attempting to receive care; and the 2009 National Health Interview Survey to examine reported reasons for the delay of care. These survey results were compared with the experiences of individuals with private insurance and with individuals who were uninsured, and the following was concluded:
4. To examine the extent to which Medicaid beneficiaries reported difficulties obtaining medical care. Medicaid beneficiaries reported experiencing no more challenges obtaining medical care and prescription medicine than those with private coverage. There was a large gap in results when it came to dental care, purportedly due to the number of states that don’t offer dental coverage in their benefits package.
This study shows a decrease in application processing times, an increase in benefits/services, frequent challenges to ensuring sufficient provider participation, and an equal response from Medicaid beneficiaries and privately insureds when it came to difficulties obtaining care. Some of these results (and especially that last one) seem counter-intuitive.
A common opinion is that Medicaid coverage, as one Wall Street Journal op-ed said last year, "is worse than no coverage at all." Some study results suggest that Medicaid patients receive lower quality care and experience worse health outcomes than those with private insurance. A graduate fellow at The Heritage Foundation's Center for Health Policy Studies, Kevin D. Dayaratna, notes than Obama's health care reform will add to this issue, "largely because it provides poorer access to care, many Medicaid patients often show up to hospitals in poor and in some cases untreatable conditions."
And then there's the question of what the definition of "difficulties" is, and if both Medicaid beneficiaries and those privately insured captured the perceived magnitude of these challenges the same way when responding to the study.
These results by no means imply that Medicaid is just as good an option as private coverage. While Medicaid beneficiaries reported as many difficulties obtaining care as those with private insurance (only in certain cases, as the study points out), what this study does not provide is an in-depth look into the quality of said obtained care.
Regardless, Medicaid pays physicians a little over 50 percent of what private insurers pay, which is bound to cause anyone to question the results of, in particular, the fourth objective in this study.