State Medicaid Reimbursement Research Articles

Medicaid Reimbursement for Common Orthopedic Trauma Procedures is 16.0% Less Compared to Medicare with Substantial Variability Between States.

This study seeks to evaluate the variability of Medicaid reimbursement and compare it to Medicare reimbursement using the 20 most commonly billed orthopedic trauma CPT codes nationwide. The authors anticipate significant variability between states and hypothesize that Medicaid payment will be significantly less than Medicare payment. The top 20 most common orthopedic trauma surgery procedural codes were identified from a previous analysis performed by Haglin et al.1 The Centers for Medicare and Medicaid services physician fee schedule was used to determine reimbursement rates from Medicare, and state Medicaid fee schedules were used to determine reimbursement rates for Medicaid. State Medicaid rates were compared to their corresponding Medicare rates to determine a dollar difference. Additionally, the dollar difference for each CPT code was divided by its respective physician relative value unit (RVU). This was utilized to acknowledge the possible variability in the complexity of orthopedic procedures and the related physician effort. The Medicare Wage Index was used to adjust Medicaid rates based on the cost of living for the state as well. Coefficients of variation were calculated to represent overall variability in Medicaid and Medicare reimbursement rates. The mean reimbursement rates for Medicaid were lower for all 20 procedures compared to Medicare. On average, Medicaid reimbursed 16.0% less than Medicare, and 29.6% less when adjusting for cost-of-living. MCD reimbursed at a higher rate than MCR for all procedures in only nine states (Alaska, Arizona, Arkansas, Montana, Nebraska, New Jersey, New Mexico, and North Dakota, and South Dakota) while 38 states reimbursed at a lower rate than MCR, on average. The coefficient of variation ranged from 0.24 to 0.34 for the Medicaid unadjusted group and from 0.35 to 0.46 for the Medicare Wage-Index adjusted group. In contrast, the Medicare group was consistent at 0.06 for all 20 procedures. The average dollar difference across the 20 CPT codes for Medicaid reimbursement compared to Medicare ranged from -$76.89 to -$225.17, and the dollar difference per relative value unit ranged from -$5.96 to -$15.16. This study found a high amount of variation between state Medicaid reimbursement rates and average rates that were significantly lower than Medicare reimbursement rates for the top twenty most utilized orthopedic trauma CPT codes as identified by Haglin et al. The discrepancy in reimbursement was increased when Medicaid rates were adjusted for state cost-of-living. Level III. See Instructions for Authors for a complete description of levels of evidence.

Safety-net Hospitals in Brooklyn, New York: A Review

Abstract: Safety-net hospitals (SNHs) provide health care services to individuals regardless of their ability to pay. These hospitals serve Medicaid recipients, the uninsured, and people with limited access to health care due to their socioeconomic status, race, or ethnicity. In addition to providing health care to the most vulnerable, SNHs are crucial in training the next generation of clinicians. Hospitals serving Medicaid patients and the uninsured have low operating margins because of a dated State Medicaid financial model, and as a result, many now face closure. This review provides historical context for the financial challenges facing SNHs in Brooklyn, New York. In addition, it examines how New York State's Medicaid reimbursement methodology threatens the viability of hospitals that serve low-income communities. Finally, the article suggests a solution to the health care crisis in Brooklyn, capitalizing on structural payment reform successes in other states.

Hourly Wages and Turnover of Community Health Workers According to US State Certification Policy and Medicaid Reimbursement, 2010-2021.

Objectives. To evaluate the effects of state community health worker (CHW) certification programs and Medicaid reimbursement for CHW services on wages and turnover. Methods. A staggered difference-in-differences design was used to compare CHWs in states with and without CHW certification or CHW Medicaid reimbursement policies. Data were derived from the 2010 to 2021 Current Population Survey in the United States. Results. CHW wages increased by $2.42 more per hour in states with certification programs than in states without programs (P = .04). Also, hourly wages increased more among White workers, men, and part-time workers (P = .04). Wages increased by $14.46 in the state with the earliest CHW certification program adoption (P < .01). Neither of the policies assessed had an effect on occupational turnover. Conclusions. CHW wages are higher in states with certification programs. However, wage gaps exist between Whites and non-Whites and between men and women. Public Health Implications. Federal, state, and employer-based strategies are needed to establish and sustain effective CHW programs to meet the needs of communities experiencing health and access disparities. (Am J Public Health. 2022;112(10):1480-1488. https://doi.org/10.2105/AJPH.2022.306965).

Charges for Initial Visits for Uninsured Patients at Musculoskeletal Urgent Care Centers in the US

In recent years, specialized musculoskeletal urgent care centers (MUCCs) have opened across the US. Uninsured patients may increasingly turn to these orthopedic-specific urgent care centers as a lower-cost alternative to emergency department or general urgent care center visits. To assess out-of-pocket costs and factors associated with these costs at MUCCs for uninsured and underinsured patients in the US. In this survey study, a national secret shopper survey was conducted in June 2019. Clinics identified as MUCCs in 50 states were contacted by telephone by investigators using a standardized script and posing as uninsured patients seeking information on the out-of-pocket charge for a new patient visit. State Medicaid expansion status, clinic Medicaid acceptance status, state Medicaid reimbursement rate, median income per zip code, and clinic region. The primary outcome was each clinic's out-of-pocket charge for a level 3 visit, defined as a new patient office visit requiring medical decision-making of low complexity. Linear regression was used to examine correlations of price with clinic policy against accepting Medicaid, median income per zip code, and Medicaid reimbursement for a level 3 visit. Of 565 MUCCs identified, 558 MUCCs were able to be contacted (98.8%); 536 of the 558 MUCCs (96.1%) disclosed a new patient visit out-of-pocket charge. Of those, 313 (58.4%) accepted Medicaid insurance and 326 (60.8%) were located in states with expanded Medicaid at the time of the survey. The mean (SD) price of a visit to an MUCC was $250 ($110). Clinic policy against accepting Medicaid (β, 22.91; 95% CI, 12.57-33.25; P < .001), higher median income per zip code (β, 0.00056; 95% CI, 0.00020-0.00092; P = .003), and increased Medicaid reimbursement for a level 3 visit (β, 0.737; 95% CI, 0.158-1.316; P = .01) were positively correlated with visit price. The overall regression was statistically significance (R2 = 0.084; P < .001). In this survey study, MUCCs charged a mean price of $250 for a new patient visit. Medicaid acceptance policy, median income per zip code, and Medicaid reimbursement for a level 3 visit were associated with differences in out-of-pocket charges. These findings suggest that accessibility to orthopedic urgent care at MUCCs may be limited for underinsured and uninsured patients.

Factors influencing dentists' willingness to treat Medicaid-enrolled adolescents.

To identify factors influencing dentists' willingness to treat Medicaid-enrolled adolescents with intellectual and developmental disabilities in Washington state. Primary data were collected by a survey instrument administered in 2017 to general and pediatric dentists who were Medicaid providers (N = 512). We administered a 40-item survey, which included 20 hypothetical scenarios involving a 12-year-old Medicaid-enrolled adolescent. Based on the characteristics of the potential patient, dentists were asked to rate their willingness to treat (1 = very likely; 5 = very unlikely). We used conjoint analytic techniques to examine the relative importance of six adolescent- and family-level factors (e.g., severity of intellectual and/or developmental disability [IDD], sugar intake, toothbrushing, caregiver beliefs about fluoride, restorative needs, appointment keeping) and state Medicaid reimbursement level (35 percent, 55 percent, 85 percent of usual, customary, and reasonable amount). Analyses focused on data from 178 dentists with complete and varied responses to the scenarios. The mean age of participants was 53.8 ± 10.5 years and 10.7 percent were pediatric dentists. The holdouts correlation statistics indicated excellent fit for the conjoint model (Pearson's R = 0.99, P < 0.0001; Kendall's tau = 0.89, P < 0.0001). Reimbursement level and appointment keeping were the most important factors in dentists' willingness to treat Medicaid-enrolled adolescents (importance scores of 26.7 and 25.7, respectively). Restorative needs, caregiver beliefs about fluoride, and IDD severity were the next most important (importance scores of 15.4, 10.6, and 8.1, respectively). Sugar intake and toothbrushing behaviors were the least important. Reimbursement and appointment keeping were the most important determinants of dentists' willingness to treat Medicaid-enrolled adolescents with IDD.

Shortages of Staff in Nursing Homes During the COVID-19 Pandemic: What are the Driving Factors?

ObjectivesDuring the Coronavirus Disease 2019 (COVID-19) pandemic, US nursing homes (NHs) have been under pressure to maintain staff levels with limited access to personal protection equipment (PPE). This study examines the prevalence and factors associated with shortages of NH staff during the COVID-19 pandemic. DesignWe obtained self-reported information on staff shortages, resident and staff exposure to COVID-19, and PPE availability from a survey conducted by the Centers for Medicare and Medicaid Services in May 2020. Multivariate logistic regressions of staff shortages with state fixed-effects were conducted to examine the effect of COVID-19 factors in NHs. Setting and Participants11,920 free-standing NHs. MeasuresThe dependent variables were self-reported shortages of licensed nurse staff, nurse aides, clinical staff, and other ancillary staff. We controlled for NH characteristics from the most recent Nursing Home Compare and Certification and Survey Provider Enhanced Reporting, market characteristics from Area Health Resources File, and state Medicaid reimbursement calculated from Truven data. ResultsOf the 11,920 NHs, 15.9%, 18.4%, 2.5%, and 9.8% reported shortages of licensed nurse staff, nurse aides, clinical staff, and other staff, respectively. Georgia and Minnesota reported the highest rates of shortages in licensed nurse and nurse aides (both >25%). Multivariate regressions suggest that shortages in licensed nurses and nurse aides were more likely in NHs having any resident with COVID-19 (adjusted odds ratio [AOR] = 1.44, 1.60, respectively) and any staff with COVID-19 (AOR = 1.37, 1.34, respectively). Having 1-week supply of PPE was associated with lower probability of staff shortages. NHs with a higher proportion of Medicare residents were less likely to experience shortages. Conclusions/ImplicationsAbundant staff shortages were reported by NHs and were mainly driven by COVID-19 factors. In the absence of appropriate staff, NHs may be unable to fulfill the requirement of infection control even under the risk of increased monetary penalties.

State Medicaid Reimbursement for Medications for Chronic Hepatitis C Infection from 2012 through 2015

BackgroundNew direct-acting antivirals (DAAs) can cure chronic hepatitis C virus (HCV) infection. High DAA prices combined with a large number of patients needing treatment may pose substantial economic burden on health systems. ObjectivesTo examine Medicaid reimbursement for medications for HCV infection before and after the availability of new DAAs overall and by state and to also assess the impact of Medicaid expansion on reimbursement for DAAs. MethodsWe calculated Medicaid reimbursements for medications for HCV infection between 2012 and 2015 in all 50 states and the District of Columbia. Outcomes included inflation-adjusted Medicaid reimbursement for medications for HCV infection, market share of individual DAAs, percentages of Medicaid outpatient pharmacy reimbursement for DAAs, and Medicaid reimbursement per Medicaid enrollee with HCV infection. ResultsMedicaid reimbursement for medications for HCV infection increased from $723 million in 2012 to $2.35 billion in 2015. We found variations in Medicaid reimbursement for DAAs between states in 2014 (up to 7.4 times HCV infection prevalence) that widened in 2015 (0.1–11.4 times HCV infection prevalence). Expansion states had significantly higher increases in reimbursement for DAAs per enrollee with HCV infection compared with non- or late-expansion states ($2178.60; 95% confidence interval $1558.90–$2798.40), controlling for pre-expansion reimbursement. ConclusionsMedicaid reimbursement for DAAs differs across states after controlling for HCV infection prevalence. A third of states contributed more than 5% to 15% of pharmacy reimbursements to DAAs. Medications for HCV infection are only one class of highly priced specialty drugs. Innovative policy strategies are needed for health systems to manage coverage for an increasing number of expensive specialty medications indicated for an increasing number of patients.

Equity in Medicaid Reimbursement for Otolaryngologists.

Objective To study state Medicaid reimbursement rates for inpatient and outpatient otolaryngology services and to compare with federal Medicare benchmarks. Study Design State and federal database query. Setting Not applicable. Methods Based on Medicare claims data, 26 of the most common Current Procedural Terminology codes reimbursed to otolaryngologists were selected and the payments recorded. These were further divided into outpatient and operative services. Medicaid payment schemes were queried for the same services in 49 states and Washington, DC. The difference in Medicaid and Medicare payment in dollars and percentage was determined and the reimbursement per relative value unit calculated. Medicaid reimbursement differences (by dollar amount and by percentage) were qualified as a shortfall or excess as compared with the Medicare benchmark. Results Marked differences in Medicaid and Medicare reimbursement exist for all services provided by otolaryngologists, most commonly as a substantial shortfall. The Medicaid shortfall varied in amount among states, and great variability in reimbursement exists within and between operative and outpatient services. Operative services were more likely than outpatient services to have a greater Medicaid shortfall. Shortfalls and excesses were not consistent among procedures or states. Conclusions The variation in Medicaid payment models reflects marked differences in the value of the same work provided by otolaryngologists-in many cases, far less than federal benchmarks. These results question the fairness of the Medicaid reimbursement scheme in otolaryngology, with potential serious implications on access to care for this underserved patient population.

Use of Veterans Affairs and Medicaid Services for Dually Enrolled Veterans.

To examine how dual coverage for nonelderly, low-income veterans by Veterans Affairs (VA) and Medicaid affects their demand for care. Veterans Affairs utilization data and Medicaid Analytic Extract Files. A retrospective, longitudinal study of VA users prior to and following enrollment in Medicaid 2006-2010. Veterans Affairs reliance, or proportion of care provided by VA, was estimated with beta-binomial models, adjusting for patient and state Medicaid program factors. In a cohort of 19,890 nonelderly veterans, VA utilization levels were similar before and after enrolling in Medicaid. VA outpatient reliance was 0.65, and VA inpatient reliance was 0.53 after Medicaid enrollment. Factors significantly associated with greater VA reliance included sociodemographic factors, having a service-connected disability, comorbidity, and higher state Medicaid reimbursement. Factors significantly associated with less VA reliance included months enrolled in Medicaid, managed care enrollment, Medicaid eligibility type, longer drive time to VA care, greater Medicaid eligibility generosity, and better Medicaid quality. Veterans Affairs utilization following new Medicaid enrollment remained relatively unchanged, and the VA continued to provide the large majority of care for dually enrolled veterans. There was variation among patients as Medicaid eligibility and other program factors influenced their use of Medicaid services.

Methadone Prescribing and Overdose and the Association with Medicaid Preferred Drug List Policies - United States, 2007-2014.

Drug overdose is a leading cause of injury death in the United States; 47,055 fatal drug overdoses were reported in 2014, a 6.5% increase from the previous year (1), driven by opioid use disorder (2,3). Methadone is an opioid prescribed for pain management and is also provided through opioid treatment programs to treat opioid use disorders. Because methadone might remain in a person's system long after the pain-relieving benefits have been exhausted, it can cause slow or shallow breathing and dangerous changes in heartbeat that might not be perceived by the patient (4,5). In December 2006, the Food and Drug Administration issued a Public Health Advisory that alerted health care professionals to reports of death and life-threatening adverse events, such as respiratory depression and cardiac arrhythmias, in patients receiving methadone (4); in January 2008, a voluntary manufacturer restriction limited distribution of the 40 mg formulation of methadone.* CDC analyzed state mortality and health care data and preferred drug list (PDL) policies to 1) compare the percentage of deaths involving methadone with the rate of prescribing methadone for pain, 2) characterize variation in methadone prescribing among payers and states, and 3) assess whether an association existed between state Medicaid reimbursement PDL policies and methadone overdose rates. The analyses found that, from 2007 to 2014, large declines in methadone-related overdose deaths occurred. Prescriptions for methadone accounted for 0.85% of all opioid prescriptions for pain in the commercially insured population and 1.1% in the Medicaid population. In addition, an association was observed between Medicaid PDLs requiring prior authorization for methadone and lower rates of methadone overdose among Medicaid enrollees. PDL policies requiring prior authorization might help to reduce the number of methadone overdoses.

Increased public reimbursement for prophylactic visits with dentists associated with increased receipt of preventive dental services in children

To determine whether higher reimbursement for children's preventive dentistry correlates with greater utilization of preventive dental care. A cross-sectional analysis of National Survey of Children's Health 2011/2012 was conducted, combined with state Medicaid reimbursement rates for preventive dentistry. Analyses included prevalence, unadjusted odds ratios, and multivariable logistic regression for receipt of preventive dental services. Of all surveyed American children 1-17 years, almost 20 percent had not received preventive dental care in prior year; this percentage is even higher in those with public insurance. Each $10 increase in state reimbursement was associated with a 17 percent decrease in odds of children not receiving preventive services. Higher state reimbursement for preventive services may increase children's receipt of preventive dental care.

Impact of state-specific Medicaid reimbursement and eligibility policies on receipt of cancer screening.

Although state Medicaid programs cover cancer screening, Medicaid beneficiaries are less likely to be screened for cancer and are more likely to present with tumors of an advanced stage than are those with other insurance. The current study was performed to determine whether state Medicaid eligibility and reimbursement policies affect the receipt of breast, cervical, and colon cancer screening among Medicaid beneficiaries. Cross-sectional regression analyses of 2007 Medicaid data from 46 states and the District of Columbia were performed to examine associations between state-specific Medicaid reimbursement/eligibility policies and receipt of cancer screening. The study sample included individuals aged 21 years to 64 years who were enrolled in fee-for-service Medicaid for at least 4 months. Subsamples eligible for each screening test were: Papanicolaou test among 2,136,511 patients, mammography among 792,470 patients, colonoscopy among 769,729 patients, and fecal occult blood test among 753,868 patients. State-specific Medicaid variables included median screening test reimbursement, income/financial asset eligibility requirements, physician copayments, and frequency of eligibility renewal. Increases in screening test reimbursement demonstrated mixed associations (positive and negative) with the likelihood of receiving screening tests among Medicaid beneficiaries. In contrast, increased reimbursements for office visits were found to be positively associated with the odds of receiving all screening tests examined, including colonoscopy (odds ratio [OR], 1.07; 95% confidence interval [95% CI], 1.06-1.08), fecal occult blood test (OR, 1.09; 95% CI, 1.08-1.10), Papanicolaou test (OR, 1.02; 95% CI, 1.02-1.03), and mammography (OR, 1.02; 95% CI, 1.02-1.03). Effects of other state-specific Medicaid policies varied across the screening tests examined. Increased reimbursement for office visits was consistently associated with an increased likelihood of being screened for cancer, and may be an important policy tool for increasing screening among this vulnerable population.

Culture Change Practice in U.S. Nursing Homes: Prevalence and Variation by State Medicaid Reimbursement Policies

To estimate the prevalence of culture change practice in U.S. nursing homes (NHs) and examine how state Medicaid policies may be associated with this prevalence. In 2009/2010, we conducted a survey of a stratified proportionate random sample of NH directors of nursing (DONs) and administrators (NHAs) at 4,149 U.S. NHs; contact was achieved with 3,695. Cooperation rates were 62.6% for NHAs and 61.5% for DONs. Questions focused on NH (physical) environment, resident-centered care, and staff empowerment domains. Domain scores were created and validated, in part, using qualitative interviews from 64 NHAs. Other NH covariate data were from Medicare/Medicaid surveys (Online Survey, Certification and Reporting), aggregated resident assessments (Minimum Data Set), and Medicare claims. Medicaid policies studied were a state's average NH reimbursement rate and pay-for-performance (P4P) reimbursement (including and not including culture change performance measures). Multivariate generalized ordered logit regressions were used. Eighty-five percent of DONs reported some culture change implementation. Controlling for NH attributes, a $10 higher Medicaid rate was associated with higher NH environment scores. Compared with NHs in non-P4P states, NHs in states with P4P including culture change performance measures had twice the likelihood of superior culture change scores across all domains, and NHs in other P4P states had superior physical environment and staff empowerment scores. Qualitative interviews supported the validity of survey results. Changes in Medicaid reimbursement policies may be a promising strategy for increasing culture change practice implementation. Future research examining NH culture change practice implementation pre-post P4P policy changes is recommended.

Medicaid Drug Selection Committees and Inadequate Management of Conflicts of Interest

Drug selection decisions for state Medicaid reimbursement programs should be based on the best available evidence and free of conflicts of interest (COIs), but little is known about how the committees identify and manage COIs of the members. The objectives of this study were to (1) describe the content of Medicaid drug selection committees' COI policies for the US states and the District of Colombia, (2) categorize the policies by strength, and (3) identify characteristics of a strong policy. For all states with Medicaid Preferred Drug Lists (47 states and the District of Columbia), we conducted a systematic search of official Medicaid websites and contacted Medicaid staff by e-mail and/or telephone to identify drug selection committee COI policies. We conducted a content analysis of the policies, extracting data on COI disclosure parameters, management strategies, and review processes using predefined categories modified through an iterative process. Policy documents were obtained for 27 of the programs (56%)-14 from websites and 13 by contacting Medicaid officials. We found high variability in COI policies, lack of public availability, and inconsistent enforcement and management of COI among states. The most common management strategy was disclosure of COI in 67% of policies (18 of 27), followed by self-recusal in 52% of policies (14 of 27). Only 15% of policies (4 of 27) ban certain relationships with industry. Current policies are not transparent and not standardized, and no state policy included all model components. Wide variations suggest that some policies may not adequately protect drug selection decisions against COI and industry influence. With expected growth of Medicaid due to health care reform, the selection of drugs for Medicaid patients should be protected from the influence of COI.

Access to care for children with autism in the context of state Medicaid reimbursement

This paper examines the role of state residence and Medicaid reimbursement rates in explaining the relationship between having autism and access to care for children. Three questions are addressed: (1) Is there variation across states in the relationship between having autism and access to care? (2) Does taking account of state residence explain a significant amount of the variation in this relationship? (3) Does accounting for Medicaid reimbursement rates enhance our understanding of this relationship? Data from the 2005 National Survey of Children with Special Health Care Needs were combined with state characteristics to estimate a hierarchical generalized linear model of the association between state residence, Medicaid reimbursement rate and problems accessing care for children with special health care needs with and without autism. Findings indicate there is significant variation between states in the relationship between having autism and problems accessing care, and accounting for state residence explains a significant amount of variation in the model. Medicaid reimbursement rates have an independent effect on access to care for children with autism: when families raising children with autism live in states with higher reimbursement rates, they have lower odds of experiencing problems accessing care. The state context in which families live impacts access to care for children with autism. Moreover, when families live in states with higher Medicaid reimbursement rates, they are less likely to experience problems getting care. The value of this analysis is that it helps identify where to look for strategies to improve access.

Association Between Medicaid Reimbursement and Child Influenza Vaccination Rates

We examined associations between influenza vaccination rates and Medicaid reimbursement rates for vaccine administration among poor children who were eligible for Medicaid (<100% of the federal poverty level in all states). We analyzed 3 consecutive National Immunization Surveys (NISs) to assess influenza vaccination rates among nationally representative children 6 to 23 months of age during the 2005-2006 (unweighted N = 12 885), 2006-2007 (unweighted N = 9238), and 2007-2008 (unweighted N = 11 785) influenza seasons (weighted N = 3.3-4.0 million per season). We categorized children into 3 income levels (poor, near-poor, or nonpoor). We performed analyses with full influenza vaccination as the dependent variable and state Medicaid reimbursement rates (continuous covariate ranging from $2 to $17.86 per vaccination) and terms with income levels as key covariates. In total, 21.0%, 21.3%, and 28.9% of all US children and 11.7%, 11.6%, and 18.8% of poor children were fully vaccinated in the 2006, 2007, and 2008 NISs, respectively. Multivariate analyses of all 3 seasons found positive significant (all P < .05) associations between state-level Medicaid reimbursement and influenza vaccination rates among poor children. A $10 increase, from $8 per influenza vaccination (the US average) to $18 (the highest state reimbursement), in the Medicaid reimbursement rate was associated with 6.0-, 9.2-, and 6.4-percentage point increases in full vaccination rates among poor children in the 2006, 2007, and 2008 NIS analyses, respectively. Medicaid reimbursement rates are strongly associated with influenza vaccination rates.

Mental Disorders and Service Use Among Welfare and Disability Program Participants in Fee-for-Service Medicaid

Mental Disorders and Service Use Among Welfare and Disability Program Participants in Fee-for-Service Medicaid

The impact of Medicaid coverage and reimbursement on access to diagnostic mammography.

Women of low socioeconomic status are at risk for delayed evaluation of abnormal mammograms and later stage presentations of breast cancer. Medicaid reimbursement for clinical services is lower than Medicare reimbursement, yet it is unclear whether low Medicaid reimbursement is a barrier to accessing mammography. The objective of the current study was to determine the association between reported insurance type (Medicaid vs Medicare), Medicaid reimbursement rate, and access to diagnostic mammography (DM). Standardized patients (SPs) called 521 mammography facilities in defined geographic regions of 11 states in 2005. Facilities were divided between high, middle, and low reimbursing states based on the state's relative Medicaid-to-Medicare reimbursement rate for DM. SPs contacted each facility twice to schedule a DM using the same clinical vignette but switching insurance status (Medicaid vs Medicare). The authors measured the proportion of SPs who were offered 1) any appointment and 2) a timely appointment, defined as a third available appointment within 20 business days. SPs with Medicaid were less likely to receive an appointment than SPs with Medicare (91% vs 99.1%; difference, 8.1%; 95% confidence interval, 5.3%-10.9% [P < .001]). Among facilities that offered appointments to both callers, the proportion of timely appointments did not differ between Medicaid (93.7%) and Medicare (92.9%; P = .51). States' Medicaid reimbursement rates for DM were not associated with the percentage of SPs with Medicaid who were offered any appointment (P = .50) or a timely appointment (P = .69). Callers with Medicaid were offered appointments for DM less frequently than callers with Medicare, although both were widely accepted. State Medicaid reimbursement rates did not affect access to mammography.

Litigation amidst Reform — The Boston Medical Center Case

In July the Boston Medical Center filed suit in Massachusetts state court challenging the state's Medicaid reimbursement formula. Wendy Parmet writes that this case raises critical questions about the Massachusetts model of health care reform as well as litigation's role in health care reform debates.

Who Cares? We Do and We Always Will

Who Cares? We Do and We Always Will