On June 30, the U.S. Government Accountability Office (GAO) released a report examining children’s access to health coverage under Medicaid and the Children’s Health Insurance Program (CHIP).  The GAO studied physicians’ willingness to care for children enrolled in the programs and physicians’ willingness to accept new children insured through them.  The authors also examined the difficulty physicians face in referring children enrolled in Medicaid and CHIP to specialty care.  The report found that 83 percent of primary care physicians and 71 percent of specialty physicians serve children enrolled in Medicaid and CHIP.  Among physicians participating in the government programs, the authors found that 79 percent are accepting new privately insured children while only 47 percent are accepting children enrolled in Medicaid or CHIP.  The report also found that non-participating physicians most commonly cite administrative issues as barriers to participation, including low and delayed reimbursements.  The GAO concluded that physicians face significant difficulty in referring Medicaid and CHIP-enrolled children to specialty care, including mental health.

From the report:

On June 23, the Kaiser Family Foundation (KFF) released a brief examining health coverage challenges facing unemployed individuals and outlining their options for maintaining coverage.  The brief notes that 13.9 million individuals were unemployed in May 2011, of whom 6.2 million had been uninsured for at least six months.  The authors suggest that individuals’ options to maintain health coverage diminish as they remain unemployed for six months or more, highlighting COBRA, public health coverage, and the individual insurance market as options for unemployed individuals to obtain health coverage.  The authors assert that implementation of the national health care reform law will result in a wider range of affordable coverage options for the unemployed.

From the report:

The Archives of Internal Medicine (AIM) has published a study examining trends in physicians’ acceptance rates for different types of health coverage and self-pay patients.  Employing data from the Centers for Disease Control and Prevention’s (CDC) National Ambulatory Medical Care Survey (NAMCS), the authors highlight the need for policymakers to understand health coverage acceptance data to address health care access issues.  The study notes that this is particularly salient in light of the current primary care physician shortage and the upcoming health coverage expansion under the national health care reform law.

Bishop, Tara F. et al. Declines in Physician Acceptance of Medicare and Private Coverage. (2011). Archives of Internal Medicine, 171 (12): 1117-1119. doi:10.1001/archinternmed.2011.251. http://archinte.ama-assn.org/cgi/content/extract/171/12/1117

Authors: Tara F. Bishop, Alex D. Federman, and Salomeh Keyhani.

The Journal of Health Politics, Policy and Law has published a study examining relative affordability of health coverage premiums under the national health care reform law and the expansion of the Children's Health Insurance Program (CHIP).  The authors compare the cost of covering a family in Illinois, Pennsylvania, and Washingon through a combination of CHIP and employer-sponsored coverage to that of a family obtaining coverage through one of the law's health exchanges. 

Gresenz, C., Laugesen, M., Yesus, A. and Escarce J.  (2011).  Relative affordability of health insurance premiums under CHIP expansion programs and the ACA.  The Journal of Health Politics, Policy and Law, 36 (3): 859-877.  doi: 10.1215/03616878-1407658.  http://jhppl.dukejournals.org/content/early/2011/07/22/03616878-1407658.full.pdf+html

Authors: Carole Gresenz, Miriam Laugensen, Ambeshie, Yesus and Jose Escarce.   

The National Association of State Alcohol and Drug Abuse Directors, Inc. has released a report examining data on publicly funded substance abuse treatment.  The authors determined that in most states most publicly funded substance abuse treatment providers accept Medicaid.  However, the authors note that there are providers who will likely need to enroll in Medicaid during the implementation of the national health care reform law, and they suggest that states and SAMHSA share best practices in encouraging provider enrollment.

From the report:

In recent discussions about needed progress to implement health care reform, concern has been expressed that too few Substance Abuse (SA) providers are enrolled to receive Medicaid reimbursement. This concern has been shared by National Association of State Alcohol and Drug Abuse Directors (NASADAD), the Substance Abuse and Mental Health Services Administration (SAMHSA), and State Associations of Addictions Services (SAAS), among others. The prevailing view was that too few SA clinics are enrolled in Medicaid. As a result SAMHSA asked the States a question about their encouragement of providers’ enrollment in Medicaid in the Substance Abuse Prevention and Treatment (SAPT) and Mental Health (MH) Block Grant Addendum (SAPT/MH).

Full report: Understanding the Baseline: Publicly Funded Substance Abuse Providers and Medicaid (PDF | 360.41 KB)

National Association of State Alcohol and Drug Abuse Directors, Inc.  (2011).  Understanding the baseline: publicly funded substance abuse providers and Medicaid.

The Kaiser Family Foundation has released a brief examining a recent Centers for Medicare & Medicaid Services (CMS) rule that would set state requirements for ensuring access to care in Medicaid.  Applying to fee-for-services (FFS) Medicaid, the rules would require states to conduct regular reviews of Medicaid-covered services to ensure that they do not prevent access to care.  The brief outlines the review process and how states must rectify access issues they identify.

From the report:

The Medicaid program today provides health and long-term care coverage for about 60 million low-income Americans, including pregnant women, children and parents, people with disabilities, and seniors. Under the Affordable Care Act, beginning in 2014, Medicaid eligibility will expand to reach nearly everyone under age 65 with income below 133% of the federal poverty level ($14,500 for an individual in 2011), bringing an additional 16 million people, mostly uninsured adults, into the program. To help ensure that Medicaid connects enrollees with the care they need, federal Medicaid law establishes a standard for access to care in Medicaid. Specifically, the federal Medicaid statute requires that payments for covered care and services “are consistent with efficiency, economy and quality of care and are sufficient to enlist enough providers so that care and services are available under the plan at least to the same extent that such care and services are available to the general population in the geographic area.

Full report: Provider Payment And Access To Medicaid Services: A Summary of CMS' May 6 Proposed Rule (PDF | 579.11 KB)

Kaiser Family Foundation.  (2011).  Provider payment and access to Medicaid services: a summary of CMS' May 6 proposed rule.