by Amanda Hinton
Medicaid enrollees of color, specifically Black and Hispanic patients, are less likely to be able to access care because racial disparities exist within the Medicaid program. A 2020 study examined primary care physician (PCP) Medicaid acceptance rates in Virginia. The researchers found that in communities with high percentages of Hispanic residents there were lower numbers of PCPs that participated in Medicaid. Another study focusing on mental health facilities had similar findings. Researchers found that communities with a larger percentage of Black and Hispanic residents were less likely to have access to a mental health facility accepting Medicaid. These studies show that communities of color have fewer providers participating in Medicaid which results in restricted access to health services.
The geographic location of providers is an important aspect of access to care for Medicaid enrollees. Researchers’ findings are more mixed regarding the location of providers and their conclusions vary depending on where the study was conducted and the racial makeup of that region. Some studies conclude that urban areas have lower physician participation in Medicaid while others conclude rural areas have lower participation. This mix of findings points to the interplay between health care infrastructure in the United States and racial disparities.
Rural communities traditionally lack health care infrastructure compared to urban areas. Typically, care is highly concentrated in these regions. There is a smaller number of physicians providing care to many individuals across a large geographic location. On the other hand, urban areas are more likely to have better health care infrastructure and more providers. But because there are more providers in total, not all of them accept Medicaid. There are large concentrations of the low-income population located in both rural and urban areas. This pattern demonstrates that depending on the study and where low-income, people of color reside determines which region will have higher numbers of physicians accepting Medicaid. These studies point to the relationship that race and location play in physician participation in Medicaid.
With all of this in mind, how should policymakers address these access issues to reduce racial disparities within Medicaid? Traditionally, it is thought that increasing Medicaid reimbursement rates to equal or exceed Medicare rates will incentivize more physicians to participate. However, increasing reimbursement rates alone will not mitigate all access issues for Medicaid patients. The expansion of Medicaid increased the demand for PCPs, but workforce capacity issues were already a concern pre-expansion. Geographic variation in PCP supply fluctuated greatly from state to state. As a result of this variation, states where Medicaid physician participation is low also have the fewest number of PCPs relative to their population. Studies show that these states already have Medicaid reimbursement rates that are equal to or exceeding Medicare. Increasing reimbursement rates alone will not solve accessibility issues if the workforce is not available.
Increasing participation in Medicaid by increasing Medicaid reimbursement rates is an important step towards increasing access to care for Medicaid enrollees but it is not the only piece of the puzzle. Policymakers need to also increase physician capacity and health care infrastructure in the United States to fill access gaps. Researchers and policymakers must continue to investigate these gaps in accessing care to ensure that all populations, especially vulnerable ones, receive the care they need. It is not enough to open the gates to people by giving them insurance; policymakers must follow through and make the services available and accessible to all.
Amanda Hinton is a student in the Master of Public Policy program with a concentration in health policy at the Bloustein School of Planning and Public Policy at Rutgers University. As a 2022 summer intern at the New Jersey State Policy Lab, Amanda researched Medicaid accessibility and the availability of providers who accept Medicaid recipients in communities of color.