This article is more than 5 years old. Information may no longer be current.

ACA improved access to pediatricians for Medicaid-insured children

Pediatric patients insured through Medicaid were more likely to be seen by pediatricians after the Affordable Care Act was enacted, especially in states that underwent Medicaid expansion, according to research presented at the Pediatric Academic Societies 2018 Meeting.

“Although Medicaid is the safety net insurance policy for children, many children on Medicaid have difficulty finding primary care providers because some physicians either do not accept Medicaid or cap the proportion of Medicaid patients they will accept,” Sean O’Leary, MD, from the University of Colorado, Aurora, and colleagues wrote. “The Affordable Care Act had several provisions designed to incentivize physicians to accept more Medicaid patients.”

To examine how the Affordable Care Act (ACA) impacted the number of patients insured through Medicaid who were accepted for treatment at pediatricians’ offices, and additional factors related to increased reporting of the acceptance of these patients because of the ACA, the researchers conducted a survey that included a nationally representative sample of pediatricians. The survey was conducted between June and September 2017.

Once responses were collected, O’Leary and colleagues used a multivariable analysis to explore the reported factors that were related to increased acceptance of Medicaid patients by pediatricians because of the ACA. The researchers considered the setting of the practice (private, public or hospital, HMO) and its location. Additionally, O’Leary and colleagues assessed how the practices made decisions, whether a cap was in place for Medicaid patient acceptance and whether the state in which the practice was located had undergone ACA Medicaid Expansion.

Of those who were contacted for the survey, 79% responded (n = 372). Most pediatricians reported that they had accepted patients insured by Medicaid within the past 10 years (92%), with 44% of these pediatricians reporting that they increased the number of Medicaid-insured patients because of the ACA; however, 54% of pediatricians reported that they observed no change in the number of Medicaid patients, and 2% reported a decrease.

A percentage cap was used for 21% of participants’ practices before the implementation of the ACA. After implementation, 54% kept the same cap and 23% reported having no cap. A decrease in percentage cap was reported by 5% of pediatricians, and an increase was reported by 11% of respondents. The status of the practice’s cap was unknown by 8%.

According to O’Leary and colleagues, multivariable analysis revealed that pediatricians who practiced within a state that underwent Medicaid expansion were linked to reports that the ACA had increased the number of patients insured through Medicaid that were accepted for treatment (RR = 1.37; 95% CI, 1.03-1.83).

“Policy makers should continue to incentivize physicians to accept Medicaid patients,” the researchers concluded. – by Katherine Bortz

Reference:

OLeary M, et al. Publication 3355. The impact of the Affordable Care Act on participation in Medicaid among pediatricians. Presented at: The Pediatric Academic Societies 2018 Meeting; May 5-8, 2018; Toronto.