Dive Brief:
- More than 80% of Medicaid enrollees rated their insurance favorably, despite over half of enrollees reporting a problem with their plans over the past year, according to a KFF brief released this week.
- Medicaid enrollees were more likely to report worse health status, stemming from barriers to receiving care, including limited provider availability and difficulty with prior authorization. As a result, Medicaid enrollees were more likely than other populations to report turning to the emergency room for care, the report found.
- However, Medicaid enrollees were less likely to report cost-related problems and more likely to report understanding their benefit coverage than those with marketplace or employer-sponsored plans.
Dive Insight:
The Affordable Care Act expanded Medicaid coverage to nearly all adults with incomes up to 138% of the federal poverty level and required states to cover Medicaid. However, the Supreme Court reversed that guidance in 2012, ruling that Medicaid expansion for states is voluntary.
Thus far, 41 states, including the District of Columbia, have expanded Medicaid, while 10 states have not, according to a KFF tracker.
The new KFF report found that Medicaid enrollees were less likely to delay treatment due to cost concerns than patients with employer-sponsored or marketplace plans.
The research firm also found Medicaid enrollees experienced fewer surprise costs, with only 11% of Medicaid enrollees reporting their insurance paid less than they expected for a medical bill, compared to 35% of individuals in employer-sponsored plans and 28% of people in marketplace plans.
Medicaid enrollees may have experienced fewer billing surprises because they generally understood their policies better than those covered by other plans.
“This comparative ease in understanding by Medicaid enrollees may be a result of limited out-of-pocket costs for Medicaid plans leading to a simpler plan design,” the report noted.
The survey, which was conducted between Feb. 21 and March 14 of this year, included more than 3,600 adults with employer-sponsored insurance plans, Medicaid, Medicare, marketplace plans or a military plan.
However, the study found Medicaid plans are not without flaws. Medicaid enrollees were more likely to report worse health status than those on other plans, some of which could be attributable to difficulty receiving recommended care or trouble with prior authorization.
A review by the HHS Office of Inspector General found that in 2019, Medicaid MCOs had an overall prior authorization denial rate of 12.5%, which was more than double the Medicare Advantage rate.
Medicaid enrollees were more likely to report difficulty finding quality providers, particularly for mental healthcare.
Low provider payments may disincentivize physicians from taking on new Medicaid patients. In 2021, the Medicaid and CHIP Payment and Access Commission found physicians were less likely to accept new Medicaid patients, though acceptance of new Medicaid patients was much higher where physicians practiced in community health centers, mental health centers, non-federal government clinics and family clinics.
The Biden Administration has taken steps this year to address the availability of providers, including releasing two proposed rules to increase transparency for fee-for-service and managed care payments, establish national maximum appointment wait time standards for managed care enrollees and requiring state monitoring related to access and network adequacy for managed care plans.
