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Medicaid acceptance by psychiatrists appears unchanged by expansion

Medicaid expansion appeared not to change the likelihood of accepting new patients with Medicaid among psychiatrists, according to a research letter published in JAMA Psychiatry.

“Without adequate participation in Medicaid among psychiatrists, Medicaid enrollees with behavioral health needs may be unable to find a local psychiatrist who accepts new patients with Medicaid or have to wait a long time for an intake appointment,” Hefei Wen, PhD, from the department of health management and policy, University of Kentucky College of Public Health, and colleagues wrote.

Using data from the 2010 to 2015 National Ambulatory Medical Care Survey, researchers compared the trend differences in physician acceptance of new patients with Medicaid across three 2-year spans (2010-2011, 2012-2013 and 2014-2015) grouped by physician specialty (psychiatry, primary care and other nonpsychiatry specialties)

They also evaluated differences in Medicaid acceptance before and after expansion between expansion and nonexpansion states by physician specialty. The pre-expansion period was 2012 through 2013 and the post-expansion period was 2014 through 2015.

Overall, 584 psychiatrists, 4,400 primary care physicians and 6,537 other specialists reported seeing new patients over the 5-year period.

Wen and colleagues found that psychiatrists were less likely than both primary care physicians and other specialists to accept new patients with Medicaid (47.93% vs. 75.78% and 76.99% in 2010-2011; 44.94% vs. 71.73% and 73.22% in 2012-2013; 35.43% vs. 71.29% and 73.33% in 2014-2015).

Analysis also indicated that the likelihood of psychiatrists accepting new patients with Medicaid decreased from 47.9% in 2010-2011 to 44.9% in 2012-2013 (P = .04) to 35.4% in 2014-2015 (P = .01). However, there was no significant change in Medicaid acceptance among primary care physicians or other specialists, according to the data.

The findings indicated that Medicaid expansion was not tied to a notable change in the odds of accepting new patients with Medicaid among psychiatrists (–7.89%; 95% CI, –40.03 to 24.24) or among PCPs (–1.82%; 95% CI, –13.38 to 9.74); however, expansion was tied to a rise in Medicaid acceptance among other specialists (14%; 95% CI, 7.12-20.89).

“This topic merits future study. The patterns we observed in Medicaid acceptance among psychiatrists over time suggest that factors other than Medicaid expansion must account for these findings,” the investigators wrote. “Future research is also needed to identify interventions, such as team-based care coordination approaches, to increase Medicaid capacity to care for patients with behavioral health care needs.” – by Savannah Demko

Disclosure: The authors report no relevant financial disclosures.