by Amanda Hinton

Medicaid has long been a vital program that provides a safety net for low-income individuals to obtain health insurance. In 2020, Medicaid covered 17.8 percent of the population in the United States. Although Medicaid covers a large portion of the population across the country, issues accessing care still exist for beneficiaries. Medicaid enrollees experience a limited choice of physicians and specialists accepting Medicaid compared to privately insured and Medicare patients.

According to research, nationally only 69.4 percent of physicians accept new Medicaid patients while 81.7 percent accept privately insured patients. In New Jersey alone, there are currently 1,846,381 people enrolled in the state’s Medicaid program, but it has the lowest percentage of physicians accepting new Medicaid patients in the nation. New Jersey physicians only accepted 40.4 percent of all new Medicaid patients despite the program providing coverage to 17 percent of the population. This has led to access gaps for low-income populations to receive needed care.

In 2010, the Affordable Care Act (ACA) expanded Medicaid to individuals who were previously excluded from being eligible. This increased insurance coverage for millions of low-income people. The expansion of Medicaid was an important piece of legislation that did increase access to care overall for a large portion of the population. However, this expanded eligibility did not acknowledge the poor health care infrastructure in the United States. Expansion did increase access but not to everyone that was newly eligible.

Prior to Medicaid expansion, problems already existed surrounding the availability of physicians accepting Medicaid patients and limited access. Previously there were locations in the United States that had severe accessibility issues that persist post-expansion. Additionally, there were historical racial disparities within the Medicaid program regarding accessing care. Prior research has demonstrated that race is a primary factor in influencing physicians’ choices to participate in Medicaid. Low acceptance rates of Medicaid by physicians are associated with reduced usage of primary care and more reports of unmet medical needs. This further widened the racial disparity gap in health care.

There is a historical context for barriers to care for Medicaid beneficiaries that were not fully taken into consideration when the ACA was passed. Increased eligibility does not always equate to increased access to care for all populations. Giving individuals health insurance is only one piece of the complex health care puzzle that needs to be put together. There are other pieces that are still missing that are needed to complete the puzzle. Although Medicaid expansion did expand care to millions of individuals, there are still questions regarding where care is concentrated and what populations can access care. Did policymakers exacerbate racial disparities through expansion because of the lack of health care infrastructure present in the United States? In my next blog post, I will explore this question and if racial disparities are related to the geographic location of Medicaid providers accepting Medicaid patients.

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.