According to a recent survey, Medicaid enrollees report worse overall health as a result of being unable to access care compared to those with other health coverage, despite giving their health insurance an overall positive rating.
KFF’s Survey of Consumer Experience with Health Insurance asked individuals covered by different types of insurance to rate the overall performance of their health insurance. The survey was conducted from Feb. 21 through Mar. 14 and focused on Medicaid recipients.
While most enrollees viewed their insurance positively, over half reported experiencing some type of problem related to cost, provider availability, or authorization in the past year.
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These problems with insurance can lead to negative outcomes for Medicaid enrollees, with nearly a quarter of individuals on Medicaid reporting that such hiccups meant they were unable to receive medical care or treatment recommended by a medical provider, ultimately leading to a decline in their health.
Access to Care a Leading Issue
Although much research indicates that individuals with Medicaid often have better access to care than people who are uninsured, obtaining healthcare has proven to be more difficult than those with private health insurance. Access to certain providers, especially psychiatrists and dentists, continues to be an ongoing challenge for Medicaid policy holders, according to a June 30 KFF article on Medicaid. While the gaps mirrored systemwide access issues plaguing healthcare, they’re exacerbated in Medicaid by myriad factors, including provider shortages in low-income communities, Medicaid’s lower physician payment rates, and lower participation in Medicaid when compared with private insurance.According to the KFF survey, one in three Medicaid enrollees report that a doctor covered by their insurance lacked available appointments and one in five adults with Medicaid report that a doctor or hospital they needed was not covered by their insurance.
In 2021, the Medicaid and CHIP Payment and Access Commission (MACPAC) found that physicians were less likely to accept Medicaid patients than those with Medicare or private insurance. For primary care, physicians were 75.8 percent likely to take new Medicaid patients versus 96.8 percent likely to take on a new patient with private health insurance. MACPAC noted the rates varied by state and that Medicaid patient rate acceptance was higher in areas that included community health centers, mental health centers, non-federal government clinics and family clinics.
When Medicaid enrollees are able to connect with a physician, prior authorization is often another barrier in access to care. According to the KFF survey, about one in five adults report their insurance denied or delayed prior approve for a treatment, service, visit or drug before they received it. The rate is double that for adults with Medicare. Individuals that often need prior authorization include patients with mental health conditions, diabetes, prescription drugs, and emergency services.
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The survey noted that individuals who utilize healthcare services more often experience more problems with their health insurance.
About Medicaid
According to the latest data available, more than 84.5 million Americans were enrolled in Medicaid. Medicaid provides health coverage to eligible low-income adults, children, pregnant women, elderly adults, and people with disabilities. KFF reports that adults with Medicaid are more likely to be younger, female, and tend to have lower incomes.Medicaid is administered by individual states in accordance to federal requirements and is funded jointly by individual states and the federal government.
Throughout the next six months, states will begin to unwind the continuous enrollment provision that has been in place for the past three years, which has provided protected coverage for millions of Americans since March 2020. Through this unwinding process, states will redetermine eligibility for those enrolled in Medicaid and disenroll those who are no longer eligible. It is estimated that some 17 million Americans will lose Medicaid coverage by May 2024.
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