A new analysis from HealthPocket, Inc., shows that while states are under increasing pressure to expand their Medicaid rolls under the Affordable Care Act (ACA), only 43 percent of doctors report that they currently accept Medicaid patients. At the same time, physician assistants (PAs) and nurse practitioners (NPs)—viewed by many as a potential solution to the primary care physician shortage—report that only 20 percent of them accept Medicaid, raising the question of whether Medicaid expansion will simply leave more Americans insured but with no one to go to for their care.

Historically, Medicaid payments to doctors have been lower than payments from both private insurance and Medicare despite being for the same service. On average, Medicaid pays doctors only 66 percent of the amount Medicare pays for the same service according to a December 2012 study by the Kaiser Family Foundation. The result of this lower reimbursement rate is a smaller pool of doctors who are willing to accept Medicaid. The ACA includes provisions to raise the reimbursements rates of Medicaid compared to Medicare and other plans, but those have not fully been implemented and offer only a temporary two-year increase.

While physician hesitancy to accept these rates is well known, HealthPocket also examined the Medicaid acceptance rates for PAs and NPs—the providers most commonly suggested as the next in line to increase healthcare capacity for new enrollees. Although reimbursement rates for these providers might be lower in nature and more compatible with the average rates; only 20 percent of physician assistants and nurse practitioners report that they currently accept Medicaid. 

"Ensuring there are sufficient healthcare providers available to the newly insured—even those with private insurance—is a major public health challenge right now," said Kev Coleman , head of research & data at HealthPocket. "But if the current Medicaid acceptance rates hold true for 2014, timely access to care for those relying on Medicaid is likely to become more difficult as enrollees increase for an already inadequate pool of doctors."

HealthPocket also compared rates in the five richest cities by average household income to the five poorest cities to examine whether an area's income had a bearing on Medicaid acceptance. HealthPocket found that the richest and poorest cities had similar Medicare acceptance rates on average despite their differences in income. Both groups had one city well below the national average for Medicaid acceptance. Among rich cities, Washington D.C., was the lowest with only 31 percent of healthcare providers documented as accepting Medicaid. Among the poorest cities, Detroit was the lowest, having the same acceptance rate as D.C. Of the 10 cities examined, the current Medicaid acceptance rates have no apparent bearing on the Medicaid expansion plans. For example, both San Diego and Philadelphia have a Medicaid acceptance rate of 42 percent;California is expanding Medicaid while Pennsylvania is not.

"No matter if you live in a city with a high or low average income, finding a Medicaid provider is a challenge," Coleman said. "New Medicaid enrollees are going to have to do some digging to make sure they can find a doctor or another type of practitioner willing to see them and accept these reimbursement rates."

The results of the study were based on data from National Provider Identifier (NPI) registry which included information self-reported by over 1 million healthcare providers regarding their current acceptance of patients covered by Medicaid. This HealthPocket InfoStat is part of a series using health plan data to produce objective, meaningful, and clarifying information and guidance for consumers navigating an ever-changing health insurance marketplace.