Why Do Some Doctors Not Accept Medicaid


Medicaid Enrollees Last In Line When Docs Accepting New Patients

How Medicaid & Obamacare Hurt the Poor – and How to Fix Them

Doctors are accepting new Medicaid patients at a far lower rate compared with new patients on Medicare or private insurance, according to a new study.

The study, released by the Medicaid and CHIP Payment and Access Commission during its Thursday meeting, examined Medicaid rates by specialty, whether the physician is in a Medicaid expansion state and by managed-care penetration status.

The study was based on an analysis of 2015 data from the National Ambulatory Medical Care Survey that asks if office-based physicians currently accept any new patients and whether they accept Medicaid as a payment source for the new patients.

Of the physicians that accept new patients, 70.8% accept new patients insured by Medicaid. That is a lower percentage than providers that accept Medicare at 85.3% and private insurance at 90%.

The survey also broke down the acceptance rate via the type of providers. General and family practice providers had an acceptance rate of 68.2% for Medicaid patients compared with 89.8% for Medicare and 91% for private insurance.

Only 35% of psychiatrists surveyed accepted new Medicaid patients but 62% accepted Medicare and private insurance.

Pediatricians had the highest rate of Medicaid patient acceptance at 78%.

But there was a difference within specialties, namely OB-GYNs. In non-expansion states, OB-GYNs had an acceptance rate of 89.6% compared with a 73% rate in states that expanded their Medicaid rolls, the study said.

Send us a letter

Medicaid Recipients Left With Few Options As More Physicians Decline

  • Kelly Washington, Contributing Writer

Amid a pandemic, the number of physicians who will accept Medicaid insurance is declining. Medicaid provides health insurance to many low-income eligible Americans. African Americans and people of color are likely to have more severe or chronic illnesses. They are also systemically impoverished, making Medicaid vital to their essential health needs. The devastating impact of living in medical health deserts combined with a growing number of physicians who refuse Medicaid will disproportionately affect African American communities and communities of color.

The COVID-19 pandemic and the faltering economy are boosting enrollment in the program. Many program recipients are having a hard time locating physicians and dentists who will accept their coverage. As Medicaid payments to physicians decrease, minority communities are vulnerable. These payments are inadequate. The reimbursements are low for many physicians. Each time a Medicaid patient walks into the exam room, and they are losing money. Many times, they do not break even, Dria H., a Healthcare Insurance Professional, says.


Kelly Washington is a freelance writer living on the Southside of Chicago. You can follow her on LinkedIn or social media at BlackBFly7 .

The Urgent Need For A Superior Medicaresystem

Theemerging refusal of physicians to see Medicare patients is anominous development. It is also yet another compelling reason whythe Bush Administration and Congress should quickly set in motionauthentic reform for Medicare by taking the following steps:

  • IncreaseMedicare payments to doctors practicing in the Medicareprogram. One way to accomplish this is to build on theMedicare Physician Payment Fairness Act of 2001 , sponsored by Representatives Michael Bilirakis andJohn Dingell and Senators Jim Jeffords , Jon Kyl, and John Breaux . This legislation would reverse the5.4 percent cut in Medicare physician reimbursement for calendaryear 2002. Meanwhile, Congress and the Administration should musterthe courage to ignore pressure tactics from politically powerfulorganizations such as the AARP and pursue reform in reimbursementsto Medicare doctors as well as comprehensive, market-based reformof the Medicare program.
  • Also Check: How To Change Address For Medicaid

    Ask Your Doctor For A Referral

    If you simply cannot afford to stick with your doctor, ask them to recommend the next best doctor in town who does accept Medicare. Your current doctor has probably already prepared for this eventuality and arranged to transfer Medicare patients to another physician’s care.

    Just because you are eligible for Medicare doesn’t mean you have to enroll in all four parts. If you have other health insuranceâfor example, you’re still working and can remain covered by your employer’s group planâyou may want to stick with that plan. Medicare Advantage Plan networks are another alternative to investigate. Physicians in those HMO-like plans have agreed to accept the network’s fees.

    Options If You Have Medicare But Your Doctor Doesn’t Accept It

    Obgyn That Accept Pregnancy Medicaid Near Me

    Not all doctors accept Medicare for the patients they see, an increasingly common occurrence. This can leave you with higher out-of-pocket costs than you anticipated and a tough decision if you really like that doctor.

    So what happens when you sign up for Medicare only to learn it’s a no-go at your favorite medico? Fortunately, you have some options.

    Recommended Reading: How To Apply For Medicaid And Food Stamps In Michigan

    If You Moved To A New Address And Had Prior Coverage

    You must provide documents that confirm both of these:

    • You moved in the last 60 days
    • Acceptable documents include government correspondence, utility bills, rental or mortgage documents, and homeowners insurance. They must include your new address and the date of the move.
  • You had health coverage at least one day during the 60 days before your move
  • Acceptable documents include correspondence from your insurance company, employer, or health coverage provider, like a government agency.
  • Note: If youre moving from a foreign country or U.S. territory, you dont have to prove you had health coverage. But the documents you submit must show a move from a foreign country or U.S. territory.
  • Key dates: Special Enrollment Periods due to a move

    Pick a plan within

    You May Like: Does Medicaid Cover Cortisone Shots

    Documents & Deadlines For Your Life Event

    Select your life event for the documents you can submit and key dates:

    Documents must be submitted within Coverage starts, if premium paid

    Already lost coverage

    60 days after date coverage ended Note: If you lost coverage more than 60 days ago, and didnt enroll sooner because you were impacted by the coronavirus disease 2019 emergency declared by FEMA, documents must show that you lost coverage since January 1, 2020.

    30 days of picking a plan

    First day of month after you pick a plan

    Will lose coverage in the future

    60 days before date coverage will end

    30 days of picking a plan

    First day of month after your coverage ends and you pick a plan

    Also Check: Michigan Medicaid Nursing Home Application

    Recommended Reading: Medicaid Out Of Country 30 Days

    The Cons Of Accepting Medicaid

    1. There is no guaranteed timing on Medicaid payments. The government can decide to delay payments to Medicaid providers at any time. There have been times when payment for services rendered have been delayed for more than 1 year. To medical providers that rely on Medicaid payments for compensation, this can mean that no money may come in for an extended period of time and theres nothing they can do about it.

    2. It may create doctor shortages in certain regions. There are many people who qualify for Medicaid and this can overwhelm the care structure that some communities have. This means some households may need to travel over 100 miles to receive the medical care that they need and those costs can be difficult to absorb. It may also mean lengthy delays in receiving care. In the Pacific Northwest, there are areas that have 6 month waiting times for someone to get in to see the doctor for checkups or non-emergency care needs.

    3. Some procedures can be refused after services are rendered. Medicaid can refuse to cover certain services because they are deemed to be experimental or even unnecessary. This can sometimes fly in the face of what the doctor decides is necessary for patient health, which ultimately means a patient doesnt always receive the care that they need because of money. Even when payment is received for services rendered, the amount of money that providers receive is often much lower than what doctors typically charge.

    Denied Medicaid : Anyone Pay Out Of Pocket For Insurance

    Why Do Some Health Care Workers Live in Poverty? | NYT Opinion

    Apparently between my husband and I, our income exceeds their standards. Which is tough to hear considering they dont take into consideration rent, bills, loans, life expenses in general because we arent left with much by the time everything is paid.

    Anyone here pay out of pocket for insurance, if so what insurance company do you go through? What do they base it off of and if youd like to share, how much do you pay? Sorry this is all just new to me. Ive never been in a spot where I needed it like this and I dont want our baby to go without.

    Paying out of pocket is our only option now so im trying to find the most reasonable price for our baby until I can get back on my feet and find a full time job with benefits. Im just a part time worker for now, no benefits. I really just need the insurance for baby and me, not my husband for now.

    Also Check: How To Get Both Medicare And Medicaid

    Can I Delegate Care Of Medicaid Patients To A Mid

    Another possible compromise scenario Dr. Cinéas suggests is using new physicians or mid-level practitioners, such as physician assistants or nurse practitioners, to manage Medicaid patients. These individuals typically earn lower salaries than the physician who owns the practice, which means you can lower your practices administrative costs by delegating the treatment of Medicaid patients to them.

    This, of course, raises its own ethical questionsa fact that isnt lost on Dr. Cinéas. The problem, she points out, is that this can leave Medicaid patients perpetually receiving care from the newest, most junior or most inexperienced practitioners.

    The assignment of junior or mid-level practitioners to the treatment of Medicaid patients is a suggestion reluctantly supported by Dr. Susan Hall, a dentist in Kansas whos quoted in a Kansas Health Institute report that focuses on the dental care of Medicaid patients in her state.

    While Dr. Hall doesnt readily support expanding the role of mid-level practitioners, she suggests that doing soand allowing these mid-level practitioners to treat Medicaid patientsis preferable to low-income patients simply not receiving care.

    Paul Ryans Claim That More And More Doctors Just Wont Take Medicaid

    The problem that were seeing in Medicaid is more and more doctors just wont take Medicaid, because they lose money on Medicaid. House Speaker Paul D. Ryan , town hall on CNN, Jan. 12, 2017

    During a town hall on Republican plans to repeal and replace the Affordable Care Act, Ryan described the need for changes to the Medicaid program at the state level. Some states made changes so that low-income enrollees could get coverage and access to care, but not all states did, he said.

    Ryan claimed that more and more doctors just wont take Medicaid because they lose money on Medicaid. He also said during the town hall that his concern was that Medicaid is so over-regulated and so bureaucratic that physicians just wont take Medicaid patients. And so our concern is that people on Medicaid cant get a doctor, and if you cant get a doctor, what good is your coverage? We explored the facts.

    Also Check: Are There Any Assisted Living Facilities That Accept Medicaid

    Nc Medicaid Managed Care Exempt

    Some beneficiaries can choose to stay in NC Medicaid Direct. This means you are not required to choose a health plan and a PCP. NCDHHS – Division of Health Benefits will send you a letter that tells you if you have the choice to enroll. You have the option to choose a health plan if you:

    • Are a federally-recognized tribal member or individual eligible for services through Indian Health Service .
    • Need certain services to address needs related to developmental disability, behavioral health or traumatic brain injury. BH covers MH and SUD

    If you are transitioning to NC Medicaid Managed Care and want to keep the PCP you have now:

    • Choose a health plan that your provider works with. If you have questions about the instructions in the letter you received ,

    To find a doctor, go to Find a provider.

    Medicare Does Not Pay Enough To Cover The Expenses Associated With The Services Provided

    Why Some Doctors Don

    Physicians are doing everything they can to reduce their expenses while keeping the quality of their care high. No matter what they do, it does not change the fact that the fees Medicare pays physicians especially primary care physicians are not enough to cover the overhead of rent, utilities, staff, benefits, malpractice, and technology.

    Each year for the past 10 years, physicians have faced the possibility of a cut in their Medicare payments. Prior to the freeze on the accumulated 27% cut slated for 2013, many physicians said they would throw in the towel and opt out of Medicare. Just as physicians breathed a sigh of relief, the sequester kicked in and a 2% cut took affect.

    According to a 2013 survey by Deloitte, a quarter of physicians would place new or additional limits on the acceptance of Medicare patients if there were potential payment changes to the Medicare program, such as lower payments or a switch to vouchers

    A July 2012 survey by the Texas Medical Association found only 58% of Texas physicians would accept any new Medicare patients.

    You May Like: Can I Get Medicaid If I Live With Someone

    Pros And Cons Of Accepting Medicaid

    One of the essential aid programs in the United States is Medicaid. It allows families who meet certain income or status qualifications the chance to receive health care services. Each program is managed individually at the state level so that individualized needs have a better chance to be met. As with any national program of support, there are some key pros and cons of accepting Medicaid that must be considered by medical providers.

    File The Hearing Request Form

    The Hearing Request Form is enclosed with the letter informing you of your denial. If you did not get a Hearing Request Form at the same time as the notice denying your services, contact DHB immediately at to request a Hearing Request Form.

    Instructions on how to file this form are on the form itself. The form must be returned by mail or by fax to OAH andNC DHHS to appeal the denial of your request for services. The mailing addresses and fax numbers will be listed on the notice you received in the mail. Faxing is generally the easiest way to send the appeal to both OAH and NC DHHS.

    Also Check: Apply For Montana Medicaid Online

    You May Like: I Have Medicare How Do I Apply For Medicaid

    Affordable Care Act Subsidized Plans After Medicaid

    Special Enrollment Status: If you lose your Medicaid health coverage, a Special Enrollment Period opens up for you. During an , you can obtain full-featured health insurance known as an Affordable Care Act plan.

    The SEP is only a 60-day window, so you have to act quickly. Tools like HealthCare.com help you determine which plan is best for your needs and budget.

    Without a Special Enrollment Period, you can enroll in a health plan only during the annual Open Enrollment Period, which generally lasts from November 1 through January 15. Once the window closes, you will be unable to enroll in healthcare coverage until the next open enrollment period.

    For example, if your Medicaid is canceled as of March 1, you will have 60 days to enroll in a health plan through Obamacare. If you dont enroll by the end of that 60-day window, you will have to wait until the next open enrollment period, and the coverage would not be effective until January 1 of the following year.

    If you know when your Medicaid plan ends, you can sign up in advance. Health insurance plans are generally effective the first day of the following month after you apply, but a new application may take some time to process.

    ACA Discounts for Low and Moderate Incomes: The cost of health insurance premiums can be intimidating, but help is available. Depending on your income level, you might receive a subsidy for ACA coverage.

    More Physicians No Longer Seeing Medicare Patients

    How doctors can help low-income patients (and still make a profit) | P.J. Parmar

    The federal health program that serves seniors and individuals with disabilities is losing doctors wholl see its patients.

    • The Centers for Medicare and Medicaid Services says the number of doctors wholl take Medicare patients is falling.
    • A combination of constant battles over reimbursement rates, red tape and payment below what services actually cost has simmered for a long time.
    • Medicare now faces the same tell-tale signs of trouble as Medicaid, the low-income health program. One-third of primary care doctors wont take new patients on Medicaid.
    • While the number of Medicare decliners remains relatively small, the trend is growing. If it continues, that could make it more difficult for seniors to get timely treatment.

    More doctors are reducing their dependence on Medicare. Theyve done this in several ways. At the same time, the Medicare population is growing because of the retirement of baby boomers now and over the next couple of decades.

    The number of doctors not accepting Medicare has more than doubled since 2009. Some 9,539 doctors dropped out of Medicare practice in 2012. Thats risen dramatically from 3,700 in 2009.

    While 685,000 doctors take Medicare patients, their frustration factor has grown.

    Read Also: Florida Department Of Children And Families Medicaid

    Dont Fall For This Trap

    If you call the HHSC to appeal, some of the case workers will try to talk you out of it and tell you it is quicker to re-apply than appeal but do not fall for it. If the mistake is on their end and you do not appeal the denial then you can be stuck with nursing home bills for the months they denied benefits for even if their denial was wrong.


    More like this

    How Do I Sign Up For Pregnancy Medicaid

    Can Uninsured...

    How To Find My Medicaid Id Number

    When Will...

    Dentist Who Accept Medicaid For Braces

    Why Medicaid...