Specialist Access Among Medicaid Managed Care Enrollees: Do Access Standards Help?

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The adoption of access standards does not improve access to specialist care among patients participating in Medicaid manage care.
The adoption of access standards does not improve access to specialist care among patients participating in Medicaid manage care.

HealthDay News — Adoption of specialty access standards does not improve access to specialists, according to a study published online in JAMA Internal Medicine.

Chima D. Ndumele, PhD, from the Yale School of Public Health in New Haven, CT, and colleagues compared ratings of access to specialists for adult Medicaid and commercial enrollees before and after implementation of standards for specialty access. Consumer Assessment of Healthcare Providers and Systems survey data were used to perform a quasiexperimental difference-in-differences analysis of 20,163 nonelderly adult Medicaid managed care (MMC) enrollees and 54,465 commercially insured enrollees in 5 states adopting access standards, and in 37,290 MMC enrollees in 5 states that previously adopted access standards.

The researchers found that before policy implementation, 69% of Medicaid enrollees and 75% of commercial enrollees reported that it was always or usually easy to get an appointment with a specialist, compared with 67% of Medicaid enrollees in states that had previously implemented access standards. In the period following the implementation of standards, no significant improvement was seen in timely access to specialty services for MMC enrollees, nor did access standards impact insurance-based disparities in access. Heterogeneity was seen across states.

"Specialty access standards did not lead to widespread improvements in access to specialist physicians," the authors write. "Meaningful improvements in access to specialty care for Medicaid recipients may require additional interventions."

References

  1. Ndumele CD, Cohen MS, Cleary PD. Association of state access standards with accessibility to specialists for Medicaid managed care enrollees [published online August 14, 2017]. JAMA Intern Med. doi:10.1001/jamainternmed.2017.3766
  2. Katz MH. Meeting the needs of patients for specialty care [published online August 14, 2017]. JAMA Intern Med. doi:10.1001/jamainternmed.2017.3778

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