State Access Standards do Little to Improve Access to Specialists in Medicaid

More needs to be done to eliminate the gap in access to specialty care for Medicaid patients, a new Yale School of Public Health study in JAMA Internal Medicine concludes. 

Medicaid patients nationwide have consistently reported less access to specialist medical care than patients with other types of coverage. While some federal regulations have been aimed at improving access to primary care, ensuring access to specialty care has largely been left to state and local agencies with national efforts lagging far behind. 

As a result, many low-income patients find themselves without adequate access to specialty care. This is particularly concerning because, as more adults have joined Medicaid in recent years through the Affordable Care Act, many have chronic conditions that require coordinated specialty care.

“As millions of individuals have gained health insurance coverage through Medicaid, it is increasingly important that we facilitate access to the full spectrum of services that may be needed by this population. Our study demonstrates that aspirational policies without appropriate monitoring or enforcement are limited in their capacity to ensure access,” said Assistant Professor Chima Ndumele, Ph.D., the study’s lead author.

As millions of individuals have gained health insurance coverage through Medicaid, it is increasingly important that we facilitate access to the full spectrum of services that may be needed by this population.

Chima Ndumele

To attempt to remedy this, new federal regulations are set to take effect in 2018 that will require Medicaid managed care plans in every state to set standards for specialty care access. These planned standards will include limits on wait time to see a specialist, as well as on distance a patient have to travel to a specialist appointment. 

Ndumele said the multistate study is the first to compare access to specialty care for Medicaid enrollees before and after the implementation of the types of regulation that are set to take effect next year. Using data from the Consumer Assessment of Healthcare Providers and Systems survey, covering the years 2005-2011, the research team compared responses from Medicaid enrollees regarding access to specialty care in five states that had previously adopted standards with the responses of both commercial beneficiaries in the same states, as well as Medicaid enrollees in matched control states where standards already existed.

The results revealed little evidence that these standards narrowed the gap in access to specialty care for Medicaid enrollees: overall, 69 percent of Medicaid enrollees and 75 percent of commercial beneficiaries in states without access standards reported that it was easy to get an appointment with a specialist prior to the implementation of access standards, and this gap between Medicaid and commercially insured enrollees persisted after the adoption of standards. 

The findings suggest that the upcoming new regulations alone may do little to improve access, and additional interventions will likely be needed. 

Former YSPH dean and Anna M.R. Lauder Professor of Public Health Paul Cleary, Ph.D., and current Ph.D. candidate Michael Cohen, co-authored the study.

This article was submitted by Elisabeth Ann Reitman on August 14, 2017.

Related People

Paul D Cleary

Anna M. R. Lauder Professor of Public Health (Health Policy) and Professor of Sociology and in the Institute for Social and Policy Studies

Chima D Ndumele

Assistant Professor of Public Health (Health Policy) and Assistant Professor in the Institution for Social and Policy Studies