Office-based Primary Care Pediatrician Participation in Medicaid, 2011/12 and 2015/16

Suk­fong S. Tang¹, Mark L. Hudak², Dennis M. Cooley³, Budd N. Shenkin⁴, Andrew D. Racine⁵.

¹Research, American Academy of Pediatrics, Elk Grove Village, IL; ²Pediatrics, University of Florida College of Medicine ­ Jacksonville, Jacksonville, FL; ³Subcommittee on Access, American Academy of Pediatrics, Elk Grove Village, IL; ⁴Bayside Medical Group, Berkeley, CA; ⁵Montefiore Medical Group, Montefiore Medical Center , Bronx, NY.

Presented at the 2017 Pediatric Academic Societies Annual Meeting.

Background: The Affordable Care Act raised Medicaid primary care payment to Medicare levels for 2013 and 2014 with the intention of encouraging physician participation in Medicaid. About 1/3 of states opted to extend the payment increase beyond 2014 using state funds after federal financing ended.

Objective: Examine national and state­level changes in Medicaid participation by primary care pediatricians between 2012 and 2016.

Methods: State­stratified AAP member survey data were collected in 2011/2012(n=10,138, response rate=50.4%) and 2015/2016(n=10,221, response rate=50.1%) to compare Medicaid participation change by 3 measures: 1) accept at least some new Medicaid patients, 2) accept all new Medicaid patients, and 3) Medicaid patients as percentage of total patients. This study includes only respondents who reported spending over 50% work hours in general pediatrics and practicing in solo, 2­physician, or group practice settings (about 54% of all respondents). Participation changes were examined nationally and in the 27 states with sufficient sample. Multivariable logistic and linear regression were used to examine interaction effects showing potential greater participation changes over time for pediatricians from states that extended the payment increase.

Results: Nationally, Medicaid participation increased for all 3 measures (Table). Pediatricians accepting some new Medicaid patients increased by 3 percentage points (p < .05), accepting all new Medicaid patients increased by 6 percentage points (p < .01) and Medicaid patient load increased 6 percentage points (p < .01). Significant gains for at least 2 of the 3 measures were observed in 7 of the 27 states, and gains were observed for at least 1 measure in 15 of 27 states. Multivariable analyses showed that pediatricians from states that extended the payment increase experienced a greater change in accepting some new patients across survey years than pediatricians for other states (+5.8% versus +2.4%, OR=1.28, CI=1.06­1.55).

Discussion: Medicaid participation by pediatricians increased nationally, but varied across states. A larger increase for states that extended the payment increase was found for accepting some new patients. Multiple factors not measured, that vary by state, likely are related to Medicaid participation changes. It is possible that any impact of the payment increase was minimized in some states based on how the increases were implemented and communicated to pediatricians.