Acceptance of New Medicaid Patients by Primary Care Physicians and Experiences with Physician Availability among Children on Medicaid or the Children’s Health Insurance Program

Although previous literature finds a positive relationship between state Medicaid physician payment levels and the percent of physicians accepting new Medicaid patients, little literature documents the extent to which different extens of physician participation in Medicaid translate into access issues for Medicaid patients. This is important since lack of participation in Medicaid among some physicians not located near places where Medicaid patients live or work may not affect access measures.  This paper estimates the percent of primary care physicians (i.e., those in pediatrics or general/family medicine) accepting new Medicaid patients by state and its association with measures of access to health care among children on Medicaid or the Children’s Health Insurance Program (CHIP).  Nationally-representative data from the 2011/2012 National Ambulatory Medical Care Survey (NAMCS) Electronic Health Record Survey and the 2011/2012 National Health Interview Survey (NHIS) were used.  Linear probability models estimated the relationship between measures of experiences with physician availability among children on Medicaid/CHIP from the NHIS and the state percent of primary care physicians accepting new Medicaid patients from the NAMCS.  Since it is difficult to draw conclusions about causality from associations estimated from cross-sectional data, some models compared the effect of state-level measures of acceptance of new Medicaid patients on access measures for Medicaid/CHIP to the effect for privately-insured children. 

The percent of primary care physicians accepting new Medicaid patients varied considerably more by state than the percent accepting new privately insured patients.  Measures of experiences with physician availability were worse for children on Medicaid/CHIP compared to private insurance, though the differences were small and the percent of children experiencing problems with physician availability was small.  However, measures of experiences with physician availability were worse for children with significant health conditions or development delay and better for children on Medicaid/CHIP who lived in states with higher rates of acceptance of new Medicaid patients compared to other children.  For example, only 4.6 percent of children on Medicaid/CHIP with a significant health condition or development delay had a doctor’s office or clinic indicate that the child’s health insurance was not accepted in states with at least 75 percent of primary care physicians accepting new Medicaid patients, compared to nearly 15 percent of children living in states with less than 60 percent of physicians accepting new Medicaid patients.   Adjusted estimates were similar.  For example, adjusted estimates using privately insured children as a comparison group indicate that children on Medicaid living in states with less than 60 percent of primary care physicians accepting new Medicaid patients were nearly 11 percentage points more likely to have had a doctor’s office tell them their insurance was not accepted and about 6 percentage points more likely to have had trouble finding a provider to see them compared to privately insured children.  I conclude that measures of experiences with physician availability for children on Medicaid/CHIP are generally good, though better in states where more primary care physicians accept new Medicaid patients compared to other states.