Medicaid acceptance rates vary among allergists, lag other specialties
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Key takeaways:
- Rates of confirmed food allergy diagnoses among children include 4.7% overall and 0.06% among children with Medicaid.
- 55.5% of allergists accept Medicaid compared with 78% of pediatricians.
WASHINGTON — Patients with Medicaid coverage face barriers in accessing food allergy care, according to a poster presented at the American Academy of Allergy, Asthma & Immunology Annual Meeting.
Rates of allergists who accept Medicaid coverage vary from state to state as well, Frances O. Ho, research assistant, Center for Food Allergy & Asthma Research, Northwestern University Feinberg School of Medicine, and colleagues wrote.
“We previously published a study that showed that claims-based prevalence of food allergy among children enrolled in Medicaid is substantially lower than that in the general population,” Ho told Healio.
The researchers hypothesized that a lack of allergy providers who accept Medicaid may be causing this disparity, creating a barrier to care for this population, she continued.
“To visualize such access to care, we developed our study idea of mapping out the geographic distribution of Medicaid acceptance in the United States,” Ho said.
Although 4.7% of children in the United States have a diagnosis of food allergy confirmed by a physician, only 0.06% of children enrolled in Medicaid have a confirmed food allergy diagnosis.
Generally, the researchers said, children with lower socioeconomic statuses experience difficulties in finding providers who are willing or able to treat them.
Refusal rates for patients who only have Medicaid are high as well, compared with patients who have both Medicare and private insurance. Low and inefficient reimbursement and presumed higher psychosocial and illness burdens among these patients drive these refusals.
However, the researchers noted correlations between physicians who practice in metropolitan areas and higher Medicaid acceptance rates.
In this study, the researchers aimed to ascertain proportions of providers who accept Medicaid, plot these rates across space to visualize geographic variabilities in access to allergy care for patients with Medicaid coverage, and identify the demographics of the neighborhoods where providers who accept Medicaid practice.
The researchers began by using the National Plan & Provider Enumeration System to identify allergists via taxonomy codes. Next, they contacted individual Medicaid state offices for lists or search engines that could provide Medicaid acceptance data.
When these offices could not provide that information or if the state had fewer than 30 providers, the researchers called every provider in the state.
When these offices could provide that information and if those states had more than 30 providers, the researchers called every 10th provider in the state. Every provider in these states were called when there was a congruence in acceptance between results from the state office and the phone calls.
These efforts yielded 5,694 providers. The investigation found that 55.5% of allergists accepted Medicaid, which the researchers noted was lower than rates for pediatrics (78%), general surgery (88%) and obstetrics/gynecology (81%).
Bilaver called the low rate of Medicaid acceptance among allergists surprising.
Thirteen of 50 states plus Washington, D.C., had acceptance rates below 50%, with rates overall ranging from 13% to 90%. The Northeast and Washington, Arizona and Texas had the lowest predicted rates.
Similarly, the Northeast and Washington, Arizona and Florida had the lowest predicted rates of allergists who accepted Medicaid per 10,000 enrollees.
The researchers further noted an association between each 5-percentage point increase in poverty at the county level and 24.5% odds for Medicaid acceptance by allergists.
Odds ratios for demographic associations with Medicaid acceptance by allergists included:
- percentage of Black/African American (2010): 0.988 (95% CI, 0.963-1.015);
- percentage of Hispanic/Latino (2010): 0.987 (95% CI, 0.966-1.009);
- percentage in poverty (2018): 1.245 (95% CI, 1.156-1.34); and
- percentage enrolled in Medicaid (2019): 0.985 (95% CI, 0.901-1.077).
Based on Rural-Urban Commuting Area codes, using the Urban designation as a reference, odds ratios for allergist Medicaid acceptance also included 1.272 (95% CI, 0.93-1.74) for large towns and 0.968 (95% CI, 0.763-1.228) for rural areas.
“Providers in a rural neighborhood were 34% less likely to accept Medicaid than providers in urban communities,” Ho said.
These results indicate disparities in access to allergy care for patients enrolled in Medicaid based on location, both within and between states, Ho said.
“This population might therefore be more likely to acquire allergy care from primary care providers who are often unable to perform skin testing and oral food challenges and will refer patients to allergy specialists, who Medicaid patients struggled to access in the first place,” she said.
These difficulties and variations in accessing care for patients with Medicaid coverage may drive established differences in health-related outcomes based on socioeconomic status, the researchers said.
The researchers proposed multiple solutions for addressing these disparities.
“At a provider level, there can be an increase in the training and guidelines primary care physicians receive in allergy-related health care,” Ho said.
Ho also recommended collaboration between primary care providers and in allergy-related health care to streamline the diagnosis, management and treatment process.
“This has been done with asthma-related health care,” she said.
Regions such as rural areas that have the fewest allergists who accept Medicaid should be targeted, the researchers said, adding that telehealth may mitigate these disparities in access as well.
Other barriers in accessing health care related to allergy, such as provider quotas for Medicaid patients, longer wait times for appointments and required referrals from primary care providers, should be identified as well, the researchers continued.
“Policies should be created that enforce parity in reimbursement rates between Medicaid and private insurance for allergy related health care,” Ho said. “This will hopefully incentivize more allergists to accept Medicaid.”