Allergists not accepting Medicaid may be creating barriers to care
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Key takeaways:
- Only 55.5% of allergists accepted Medicaid.
- Medicaid acceptance rates ranged from 13% to 90% across different states.
Finding an allergist that accepts Medicaid may be contributing to a lack of access to allergy-related health care, according to a study published in The American Journal of Managed Care.
“We did a study in 2021 that found very low rates of food allergy diagnoses among Medicaid-enrolled children,” Lucy Bilaver, PhD, associate professor in the department of pediatrics at Northwestern University Feinberg School of Medicine, told Healio. “We hypothesized that access to allergy care was part of the reason for the low prevalence of food allergy (0.6% overall).”
The National Plan and Provider Enumeration System (NPPES) was used to identify allergists by taxonomy codes in October 2020. To determine whether allergists accepted Medicaid, researchers asked Medicaid offices in the 50 U.S. states and the District of Columbia for electronic lists of providers, NPI numbers and/or made direct calls to provider offices. These efforts were completed between June 2021 and March 2023.
Among 5,694 providers from the NPPES, 55.5% were found to accept Medicaid. An acceptance rate 50% or less was found in 13 states/districts. The range of acceptance across all states/districts was 13.4% to 89.5%.
“We were surprised about the wide range of Medicaid acceptance across,” Bilaver said. “We expected there to be variation given the variation in the Medicaid programs, but this was more than we expected.”
The lowest numbers of allergy providers were seen in Wyoming (n = 3), South Dakota (n = 6) and Vermont (n = 7). The highest rates of Medicaid acceptance were seen in New Mexico (89.5%; allergy providers = 19), Alaska (88.9%; allergy providers = 9) and Oregon (85%; allergy providers = 40). The lowest rates were found in New York (13.4%; allergy providers = 500), Nevada (26.1%; allergy providers = 23), Washington (33.3%; allergy providers = 126) and Wyoming (33.3%; allergy providers = 3).
The highest predicted rates of acceptance according to a map of proportions of allergists who accept Medicaid are in the West Coast and Mountain state regions. The lowest predicted rates occur in the Northeast region, Washington, Arizona and Texas.
Among regions where allergists who accept Medicaid per 10,000 enrollees, predicted rates were highest in Virginia, the upper Midwest and southeastern Idaho. The lowest were in the Northeast region, Washington, Arizona and Florida.
There was a total of 297 allergy providers in rural neighborhoods. Rural or large town neighborhood status had no effect on Medicaid acceptance. A 5-point percentage increase in the proportion of a below federal poverty level population was linked to a higher proportion of Medicaid-accepting providers (P < .0001).
“It is surprising that a patient with food allergy and Medicaid insurance can have such different experiences finding a provider who accepts their insurance,” Bilaver said. “Fewer providers undoubtedly mean longer wait times for care.”
Bilaver explained that doctors should be aware that referrals to allergists in the Medicaid program may take longer than referrals to providers accepting other insurance types.
“Primary care physicians who are concerned about possible IgE-mediated allergic reactions should counsel patients about how to address future reactions if confirmation by an allergist is going to take months to complete,” she said.
This study shows that barriers to allergy care among Medicaid-enrolled patients exist, according to Bilaver.
“This barrier is particularly important to address given the increase in the prevalence of food allergies in the past decades,” she said. “Living with unconfirmed food allergies can lead to unnecessarily restricted diets and impacts on quality of life, not to mention the importance of having access to lifesaving epinephrine for reaction.”
For more information:
Lucy Bilaver, PhD, can be reached at l-bilaver@northwestern.edu.