Jeffrey Wade
Medicaid is a key source of coverage for individuals experiencing homelessness, those transitioning out of carceral settings, and those with lower incomes. It covers 1 in 5 people in the United States and is the primary payer for long-term care, covering 61% of total spending. However, it is well-documented that many doctors do not accept new patients with Medicaid. This is due to lower reimbursement rates compared to Medicare and private insurance, with only 71% of providers accepting Medicaid. This has led to criticism that doctors are worsening health disparities and breaching their social contract.
| Characteristics | Values |
|---|---|
| Doctors' acceptance of Medicaid | Up to 1 in 3 physicians are not willing to accept new Medicaid patients. |
| Doctors' refusal of Medicaid | Doctors who refuse to accept Medicaid patients are said to breach their social contract and worsen disparities in health. |
| Medicaid beneficiaries' access to care | Beneficiaries have better access to care than the uninsured and comparable rates to private insurance, but there are still gaps in access to certain providers (e.g., psychiatrists and dentists). |
| Medicaid coverage | Medicaid covers 1 in 5 people in the US, with higher percentages in states that expanded Medicaid under the ACA and in states with lower average incomes and lower rates of employer-provided health insurance. |
| State-level variation | Medicaid programs vary by state, and each state maintains its list of professionals accepting Medicaid. |
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What You'll Learn
- Doctors are less likely to accept Medicaid than other insurance policies
- Only 71% of providers accept Medicaid
- Doctors who refuse to accept Medicaid patients breach their social contract
- Medicaid beneficiaries have better access to care than uninsured people
- Each state maintains its own list of professionals that accept Medicaid
Doctors are less likely to accept Medicaid than other insurance policies
Medicaid is a health insurance program for people with low incomes or certain disabilities. About 72 million people, or about a fifth of the population of the United States, are enrolled in the program. Medicaid covers 41% of all births in the country, nearly half of children with special health care needs, 5 in 8 nursing home residents, 29% of non-elderly adults with any mental illness, and 40% of non-elderly adults with HIV.
Medicaid expansion under the Affordable Care Act (ACA) was supposed to reduce the number of uninsured Americans. However, doctors are less likely to accept Medicaid than other insurance policies. A likely reason for this is that Medicaid claims are paid at a lower rate than other insurance policies. According to a report, more providers would be interested in Medicaid if the reimbursements were similar to Medicare payments.
MACPAC found that only 71% of providers accept Medicaid, compared to 85% for Medicare and 90% for private insurance. Physicians in general/family practice were less likely to accept Medicaid patients (68%) than Medicare (90%) or private insurance (91%). Only 36% of psychiatrists accepted new Medicaid patients, compared to 62% for the other two. Pediatricians accepted new Medicaid patients at a lower rate (78%) than privately insured patients (91%). However, pediatricians had one of the highest percentages of specialists who accept Medicaid patients.
Medicaid beneficiaries have better access to care than uninsured people and are less likely to postpone or go without needed care due to cost. However, gaps in access to certain providers (e.g. psychiatrists and dentists) remain a challenge. Medicaid patients have greater difficulty obtaining appointments compared with privately insured patients across a variety of medical scenarios.
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Only 71% of providers accept Medicaid
Medicaid is a key source of coverage for certain populations in the United States. In 2023, it covered nearly 4 in 10 children, over 8 in 10 children in poverty, 1 in 6 adults, and almost half of adults in poverty. It is also a primary source of coverage for individuals experiencing homelessness and those transitioning out of carceral settings.
Medicaid covers a higher share of Black, Hispanic, and American Indian or Alaska Native (AIAN) children and adults compared to White children and adults. It also covers 41% of all births in the United States, nearly half of children with special health care needs, 5 in 8 nursing home residents, 29% of non-elderly adults with any mental illness, and 40% of non-elderly adults with HIV.
Despite the importance of Medicaid, there are challenges in accessing certain providers, such as psychiatrists and dentists, due to potential system-wide problems and provider shortages in low-income communities. One significant issue is that not all doctors accept Medicaid patients. According to a MACPAC report, only 71% of providers accept Medicaid, compared to 85% for Medicare and 90% for private insurance. This discrepancy is likely due to lower reimbursement rates for Medicaid, which can be a disincentive for physicians.
The percentage of physicians accepting new Medicaid patients varies by state, ranging from 39% in New Jersey to 97% in Nebraska. Physician participation in Medicaid is generally highest in the most rural states, with a median participation rate of 90% in states where at least half the population lives in rural areas. This may be because rural areas have a higher proportion of low-income patients who rely on Medicaid.
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Doctors who refuse to accept Medicaid patients breach their social contract
Medicaid is a key source of coverage for certain populations in the United States. In 2023, it covered nearly 4 in 10 children, over 8 in 10 children in poverty, 1 in 6 adults, and almost half of adults in poverty. It also covers a higher share of Black, Hispanic, and American Indian or Alaska Native (AIAN) children and adults compared to White children and adults.
Despite this, many doctors refuse to accept new patients with Medicaid. A likely reason for this is that Medicaid claims are paid at a lower rate than other insurance providers. According to a report, more providers would be interested in Medicaid if the program's reimbursements were similar to Medicare payments. Only 71% of providers accept Medicaid, compared to 85% for Medicare and 90% for private insurance. This refusal by doctors to accept new patients with Medicaid is a breach of their social contract and is a form of discrimination.
The Hippocratic oath, in its modern version, called “Medical Professionalism in the New Millennium: A Physician Charter,” demands that physicians work to “eliminate discrimination in healthcare, whether based on race, gender, socioeconomic status, ethnicity, religion, or any other social category.” The U.S. government invests $15 billion each year in the training of doctors, or $150,000 per year for each resident physician. This level of public support is unmatched by any other profession. Thus, physicians have a moral responsibility to accept Medicaid, the insurer of society's most underprivileged and vulnerable, and to not worsen the structural inequities of separate but equal in the healthcare system.
Some doctors argue that they are justified in refusing to accept Medicaid patients because of the low reimbursement rates, which are often lower than the cost of providing the service. However, this argument ignores the fact that Medicaid provides coverage for many people who would otherwise be unable to afford any healthcare at all. By refusing to accept Medicaid patients, doctors are contributing to the problem of unequal access to healthcare and are failing to uphold their social contract.
While the Affordable Care Act (ACA) has led to some improvements in access to primary care, the acceptance rate of patients covered by Medicaid remains low. This is a pressing issue that needs to be addressed to ensure that all members of society have equal access to healthcare, regardless of their social or economic status.
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Medicaid beneficiaries have better access to care than uninsured people
Medicaid is a program that provides comprehensive health and long-term care coverage to around 83 million low-income people in the United States. It is jointly financed by states and the federal government but administered by states within broad federal rules. Medicaid covers 1 in 5 people in the US, and this percentage tends to be higher in the 41 states that expanded Medicaid under the Affordable Care Act (ACA). Medicaid is a key source of coverage for certain populations, including children, adults in poverty, and individuals experiencing homelessness.
Medicaid beneficiaries have substantially better access to care than uninsured people, who are also primarily low-income. They are less likely to postpone or go without necessary care due to cost, as federal rules generally limit out-of-pocket Medicaid costs. Research shows that Medicaid beneficiaries access healthcare at rates comparable to those with private insurance and at much higher rates than the uninsured. For example, 95% of children covered by Medicaid have a usual source of care, compared to 69% of uninsured children. Similarly, nearly 90% of non-elderly adults with Medicaid have a usual source of care, while less than half of uninsured adults do.
Medicaid also provides benefits not usually covered by health insurance, such as non-emergency medical transportation, which helps enrollees get to appointments. Medicaid covers services required by federal law, and states may elect to cover optional benefits like prescription drugs and home care. Medicaid pays Medicare premiums and often provides wraparound coverage for services not covered by Medicare, such as long-term care, for nearly 1 in 5 Medicare beneficiaries.
However, it is important to note that gaps in access to certain providers, such as psychiatrists and dentists, remain a challenge in Medicaid. These gaps may be exacerbated by provider shortages in low-income communities, lower Medicaid physician payment rates, and lower Medicaid physician participation compared to private insurance. Only about 71% of providers accept Medicaid, compared to 85% for Medicare and 90% for private insurance.
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Each state maintains its own list of professionals that accept Medicaid
Medicaid is a crucial source of coverage for specific populations, including children, parents, pregnant people, elderly people with certain incomes, and people with disabilities. It also covers individuals experiencing homelessness and those transitioning out of incarceration. In 2023, it covered nearly 4 in 10 children, over 8 in 10 children in poverty, 1 in 6 adults, and almost half of the adults in poverty.
Medicaid programs vary by state, and each state Medicaid agency maintains its own list of professionals that accept Medicaid. These professionals include doctors, who are less likely to accept Medicaid than other types of insurance due to lower physician payment rates and lower Medicaid physician participation compared to private insurance. However, Medicaid beneficiaries have better access to care than uninsured people and are less likely to postpone or go without necessary treatment due to costs.
To find a doctor that accepts Medicaid, you can refer to your state's Medicaid agency list. You can also contact your health plan or visit the Medicaid & CHIP page on Healthcare.gov for more information. Other directories on MedlinePlus can help locate health professionals, services, and facilities that may accept Medicaid payments. Additionally, you can call 1-800-MEDICARE (1-800-633-4227) for assistance in finding a provider.
While Medicaid coverage varies among states, all states offer certain core benefits. These include prescription drugs and home care, also known as home and community-based services (HCBS), provided in non-institutional settings such as homes, daycare centers, and assisted living facilities. Long-term care is also covered in institutions such as nursing facilities, with Medicaid paying for 61% of total spending in this area.
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Frequently asked questions
Doctors are less likely to accept Medicaid insurance compared to other insurance types. However, it is not true that all doctors refuse to accept Medicaid patients.
Doctors who refuse to accept Medicaid patients worsen existing disparities in health and breach their social contract. However, lower Medicaid physician participation compared to private insurance may be due to lower physician payment rates and provider shortages in low-income communities.
Each state Medicaid agency maintains its own list of professionals that accept Medicaid. Contact your health plan or your state's Medicaid agency for further assistance.
There is no difference in Medicaid acceptance between doctors in states that expanded the program under the ACA and those that didn't, except with OB-GYNs.
