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State shifts to Medicaid managed care may limit poor patients' access to specialists

A growing number of State Medicaid programs for the poor are converting from fee-for-service (FFS) to managed care, a move that may limit poor patients' access to specialists, suggests a study supported by the Agency for Healthcare Research and Quality (HS09557). A representative sample of California specialists were as likely as primary care physicians (PCPs) to have Medicaid (Medi-Cal) patients in their practices at the time of the study. However, among those accepting new Medi-Cal patients, 62 percent of specialists and 80 percent of PCPs were willing to take Medi-Cal managed care patients.

Specialists and PCPs in group practices—especially those in group model health maintenance organizations (HMOs)—were significantly more likely to accept new Medi-Cal managed care patients than physicians in solo practice. Also, black, Asian, and Hispanic doctors were nearly three times as likely as white doctors to accept new Medi-Cal managed care patients.

Decreased access to specialists may be mitigated if States are able to contract with group model HMOs and to recruit minority physicians, note the researchers. They point out, however, that the lack of sufficient numbers of group model HMOs willing to contract with Medicaid and recent declines in minority enrollments in U.S. medical schools may mean that States will have to seek other ways to deal with decreased access to specialists. For this study, the researchers surveyed 962 specialist physicians and 713 PCPs practicing in California in 1998. At the time, California had 47 percent of Medicaid-insured individuals in managed care and paid among the Nation's lowest physician fees.

See "Specialists' and primary care physicians' participation in Medicaid managed care," by Lisa Backus, M.D., Ph.D., Dennis Osmond, Ph.D., Kevin Grumbach, M.D., and others, in the December 2001 Journal of General Internal Medicine 16, pp. 815-821.

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