Limited Impacts of the Medicaid Fee Bump on Access to Care

Medicaid payment rates for primary care are substantially lower than Medicare or private insurance payment rates in nearly all U.S. states. Concerns around access to care, disparities in care, and quality of care have been linked in the literature to low Medicaid payments rates. To address access in the wake of the Affordable Care Act’s (ACA) anticipated Medicaid expansion, the ACA temporarily raised certain Medicaid physician payments for eligible providers during calendar year 2013-14 for all U.S. states, a provision known informally as the “Medicaid fee bump.” To date, this policy has cost the federal government at least $7.1 billion. The effects of such a large expenditure raise critical health and public policy questions. Chief among these, did the law actually improve access to care to Medicaid beneficiaries?

This study uses the household component of the 2012 and 2013 Medical Expenditure Panel Survey (MEPS) to measure changes in the annual utilization rate of physician office visits, rates of having received a checkup in the past 2 years, and 3 measures of access (having a usual source of care, being unable to access necessary medical care, and being unable to get prescription medications). Pooled cross-section regressions were conducted on the sample less than age 65. Simple difference-in-difference regressions were used to estimate the difference in rates for 2 comparison groups: 1) Medicaid beneficiaries vs. all others, including uninsured, and 2) Medicaid beneficiaries vs. all other insurance. Control variables included demographics (age, sex, race/ethnicity, education), employment, employer health insurance benefit availability, household income, region, urban/rural, and health status.

                For utilization, rates of any office visit were significantly higher for both comparison groups, +1.05% for all (Medicaid: 70.3% in 2013, 65.7% in 2014; all others: 61.1%, 57.6%) and +0.79% for other insured (Medicaid as above; all others: 72.0%, 68.2%). Rates of any checkup in the past 2 years were also significantly higher in Medicaid for both comparisons, +0.75% for all (Medicaid: 90.9% in 2013, 88.1% in 2014; all others: 85.4%, 83.3%) and +1.63% for other insured (Medicaid as above; all others: 90.7%, 89.6%).    No statistically significant changes in access to care between 2013 and 2012 were found. On the most direct measure of access (having a usual source of care), Medicaid rates were fractionally lower in both comparisons. Rates of being unable to access medical care of prescription medication were higher in Medicaid in both comparisons.

                Based on preliminary results, the fee bump had no significant impact on access to care during the first year it was in effect, although utilization rates of primary care and physician checkups increased. Future studies will need to explore the second year of the policy (which may be confounded with broader ACA changes) and state-level differences. Analyses of secondary questions about expenditures, differences in Medicaid managed care, and disparities are important parts of our ongoing and future research.