Effects of Medicaid Physician Fees and Copayments on Access to Care

Objectives: The purpose of this project is to model the effects of temporary changes in Medicaid physician fees and removal of preventive care copayment rates and in the Patient Protection and Affordable Care Act of 2010 (PPACA) on the use of US Preventive Services Task Force (USPSTF) recommended preventive care among Medicaid enrollees. Federal law does not define preventive services, include services under a mandatory benefit category or track specific preventive services covered by each Medicaid program. This has led to substantial geographic variation in Medicaid plan design and use of preventive services, with not all USPSTF services covered in all states and substantial differences in provider reimbursement and beneficiary cost sharing. PPACA appropriates federal dollars to fund increases in physician fees for the Medicaid program for 2013-2014. After 2014, the federal incentive expires and it is up to states to determine if they will continue to fund the payment increase using state funds if Congress does not fund an extension. Methods: We used data from the 2002-2008 Medical Expenditure Panel Survey (MEPS), a national probability sample of the U.S. civilian, noninstitutionalized population. The sample included 115,335 respondents aged 19 to 64 in the 29 most populous states. The unit of analysis was the report of receiving a USPSTF recommended preventive service. The probability of changes in use of recommended services was modeled using probit difference-in-difference models.

Results: Utilization rates of preventive services by Medicaid enrollees vary across states and service type, and were consistently lower than those of the privately insured yet higher than those of the uninsured. Among key USPSTF recommended services, nearly 85% of female enrollees reported a pap smear in the past three years, and 71% had a mammogram. Fecal screening was reported by 19% of enrollees aged 50 and older, and 40% reported a colonoscopy. Blood pressure checks were reported by 80% and cholesterol screening for 75% of enrollees. Results from difference-in-difference models suggest that changes in physician fees and cost sharing did not have a significant effect on Medicaid enrollees' utilization of USPSTF recommended preventive services.

Conclusions: PPACA makes substantial though temporary – expiring in 2014 – changes to covered benefits, primary care provider payments, and cost sharing of preventive services for Medicaid enrollees. Our results suggest that although these changes may have other desirable effects, they are unlikely to substantially increase use of USPSTF recommended preventive care services among Medicaid enrollees.