Medicaid access better than Bronze plans

Managed care is the most common delivery system for Medicaid, but it is often scrutinized because funding the care represents such a large portion of state budgets. Access is one sticking point in particular.

Jeff Myers, president and CEO of Medicaid Health Plans of America, says politicians often question whether Medicaid plans have adequate networks. However, he believes, “it’s a funny argument,” because the vast majority of managed Medicaid plans have more robust networks than the Bronze plans in the exchanges.

The state dictates coverage and access, so the plans come into each market with regulations to follow for network adequacy. Rules might also dictate the maximum amount of time a patient would have to wait for an appointment with a specialist.

“The truth of the matter is most Medicaid plans have relatively robust networks because we have a state and a federal overseer to ensure that is the case,” he says.

When fee-for-service populations move into managed Medicaid, the local provider community might not be sufficient enough to cover the demand, but it’s a function of the supply of providers-rather than the contracting activities of the plans, he says. When access issues do arise, two best practices include: using telemedicine to stretch the reach of physicians; and transportation services to allow members to travel to providers outside of their immediate neighborhood.

Shoring up primary care

Under ACA, Medicaid primary care physicians must be paid Medicare rates this year and next year. While that might seem like a solution to recruit more PCPs,  the policy causes some logistical concerns, according to Myers.

“[Managed Medicaid] plans are generally on the hook to ensure flowthrough money gets to the primary care physician, but in a lot of cases, if a plan has a contracted group of physicians, there are some challenges,” he says. “But the thing that we remind policymakers is that part of our job as a managed network is to negotiate use and provider payment. And most of our plans look at payment as a way to encourage providers to provide quality care.”

For example, the bump in PCP payment could contradict existing bonus programs or other negotiated quality incentives. Individual physicians must be guaranteed their higher payment but in some cases, the payment administration isn’t designed to separate PCPs from other physicians in a group. Likewise, PCPs aren’t usually contracted for specific dollar amounts, but rather, the contract is a reflection of comprehensive compensation arrangements.