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Factors influencing primary care providers' decisions to accept new Medicaid patients under Michigan's Medicaid expansion.
- Source :
-
The American journal of managed care [Am J Manag Care] 2019 Mar; Vol. 25 (3), pp. 120-127. - Publication Year :
- 2019
-
Abstract
- Objectives: Michigan expanded Medicaid under the Affordable Care Act (ACA) through a federal waiver that permitted state-mandated features, including an emphasis on primary care. We investigated the factors associated with Michigan primary care providers (PCPs)' decision to accept new Medicaid patients under Medicaid expansion.<br />Study Design: Statewide survey of PCPs informed by semistructured interviews.<br />Methods: After Michigan expanded Medicaid on April 1, 2014, we surveyed 2104 PCPs (including physician and nonphysician providers, such as nurse practitioners and physician assistants) with 12 or more assigned Medicaid expansion enrollees (response rate, 56%). To guide survey development and interpretation, we interviewed a separate group of 19 PCPs with Medicaid expansion enrollees from diverse urban and rural regions. Survey questions assessed PCPs' current acceptance of new Medicaid patients.<br />Results: Of the 2104 surveyed PCPs, 78% reported that they were currently accepting additional Medicaid patients; 58% reported having at least some influence on the decision. Factors considered very/moderately important to the Medicaid acceptance decision included practice capacity to accept any new patients (69%), availability of specialists for Medicaid patients (56%), reimbursement amount (56%), psychosocial needs of Medicaid patients (50%), and illness burden of Medicaid patients (46%). PCPs accepting new Medicaid patients tended to be female, minorities, nonphysician providers, specialized in internal medicine, paid by salary, or working in practices with Medicaid-predominant payer mixes.<br />Conclusions: In the era after Medicaid expansion, PCPs placed importance on practice capacity, specialist availability, and patients' medical and psychosocial needs when deciding whether to accept new Medicaid patients. To maintain primary care access for low-income patients with Medicaid, future efforts should focus on enhancing the diversity of the PCP workforce, encouraging healthcare professional training in underserved settings, and promoting practice-level innovations in scheduling and integration of specialist care.
- Subjects :
- Adult
Female
Health Services Accessibility statistics & numerical data
Humans
Insurance, Health, Reimbursement
Interviews as Topic
Male
Michigan
Middle Aged
Patient Protection and Affordable Care Act
Practice Patterns, Physicians'
Residence Characteristics
Sex Factors
Specialization statistics & numerical data
United States
Health Personnel statistics & numerical data
Medicaid statistics & numerical data
Primary Health Care statistics & numerical data
Subjects
Details
- Language :
- English
- ISSN :
- 1936-2692
- Volume :
- 25
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- The American journal of managed care
- Publication Type :
- Academic Journal
- Accession number :
- 30875180