Loren Saulsberry1,2, Veri Seo3, Vicki Fung3,4. 1. Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, Boston, MA, USA. lsaulsberry@uchicago.edu. 2. Department of Public Health Sciences, The University of Chicago, Chicago, IL, USA. lsaulsberry@uchicago.edu. 3. Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, Boston, MA, USA. 4. Department of Medicine, Harvard Medical School, Boston, MA, USA.
Abstract
BACKGROUND: Changing Medicaid fees is a common approach for states to address budget fluctuations, and many currently set Medicaid physician fees at levels lower than Medicare and private insurers. The Affordable Care Act included a temporary Medicaid fee bump for primary care providers (PCPs) in 2013-2014 that recently led to both an increase and then subsequent decrease in PCP fees in many states. OBJECTIVE: To conduct a systematic literature review on the effects of changing Medicaid fees on provider participation and enrollees' access to care and service use. METHODS: We searched PubMed/Medline and JSTOR and identified 18 studies that assessed the longitudinal impact of provider fee changes in Medicaid on the outcomes of interest. We summarized information on study design, methods, and findings. RESULTS: Seven studies examined the impact of fee changes on provider participation in Medicaid. Of these, three studies found that fee increases were associated with positive effects on providers' likelihood of accepting Medicaid patients or on their Medicaid caseloads. Five studies that examined the impact of fee changes on Medicaid enrollees' access to care found a positive association with one or more access measure, such as having a usual source of care or appointment availability. Lastly, eight of 14 studies that examined service use found positive associations between fee changes and at least one measure of use, such as changes in the probability of enrollees having any visit, the number of visits, and shifts in the site of care toward office-based care; others largely did not find significant associations. CONCLUSIONS: There is mixed evidence on the impact of changing Medicaid fees on provider participation and enrollees' service use; however, increasing fees appears to have more consistent positive effects on access to care. Whether these improvements in access translate into better health outcomes or downstream cost savings are critical questions.
BACKGROUND: Changing Medicaid fees is a common approach for states to address budget fluctuations, and many currently set Medicaid physician fees at levels lower than Medicare and private insurers. The Affordable Care Act included a temporary Medicaid fee bump for primary care providers (PCPs) in 2013-2014 that recently led to both an increase and then subsequent decrease in PCP fees in many states. OBJECTIVE: To conduct a systematic literature review on the effects of changing Medicaid fees on provider participation and enrollees' access to care and service use. METHODS: We searched PubMed/Medline and JSTOR and identified 18 studies that assessed the longitudinal impact of provider fee changes in Medicaid on the outcomes of interest. We summarized information on study design, methods, and findings. RESULTS: Seven studies examined the impact of fee changes on provider participation in Medicaid. Of these, three studies found that fee increases were associated with positive effects on providers' likelihood of accepting Medicaid patients or on their Medicaid caseloads. Five studies that examined the impact of fee changes on Medicaid enrollees' access to care found a positive association with one or more access measure, such as having a usual source of care or appointment availability. Lastly, eight of 14 studies that examined service use found positive associations between fee changes and at least one measure of use, such as changes in the probability of enrollees having any visit, the number of visits, and shifts in the site of care toward office-based care; others largely did not find significant associations. CONCLUSIONS: There is mixed evidence on the impact of changing Medicaid fees on provider participation and enrollees' service use; however, increasing fees appears to have more consistent positive effects on access to care. Whether these improvements in access translate into better health outcomes or downstream cost savings are critical questions.
Entities:
Keywords:
Medicaid; access to care; health policy; utilization
Authors: Daniel Polsky; Michael Richards; Simon Basseyn; Douglas Wissoker; Genevieve M Kenney; Stephen Zuckerman; Karin V Rhodes Journal: N Engl J Med Date: 2015-01-21 Impact factor: 91.245
Authors: Molly Candon; Stephen Zuckerman; Douglas Wissoker; Brendan Saloner; Genevieve M Kenney; Karin Rhodes; Daniel Polsky Journal: JAMA Intern Med Date: 2018-01-01 Impact factor: 21.873
Authors: Ashley M Kranz; Grace Gahlon; Andrew W Dick; Sarah L Goff; Christopher Whaley; Kimberley H Geissler Journal: Health Serv Res Date: 2022-05-10 Impact factor: 3.734
Authors: Ashley M Kranz; Isaac M Opper; Ingrid Estrada-Darley; Evan Goldstein; Bradley D Stein; Andrew W Dick Journal: Med Care Date: 2021-06-01 Impact factor: 3.178