More Children with Insurance and No Medical Care

On March 31, 2014, Dr. Katie Collins commented on insurance company restrictions as to where patients can receive covered care. The post highlighted that having insurance does not guarantee that a family can see their preferred medical providers. As we continue to educate families on network restrictions, we must also address another population that has insurance but restricted access to healthcare: the child enrolled in Medicaid.

There are many children enrolled in Medicaid who are unable to access a primary care provider. There are simply not enough primary care providers who are accepting new Medicaid patients. Therefore, as the patients get turned away from clinics that do not accept Medicaid, they have only emergency rooms and urgent care centers to rely on for medical care. This type of care is expensive and lacks continuity. Children can suffer extensively due to the lack of a provider who knows their medical picture as a whole.

Consider, for example, a patient who receives a diagnosis of asthma in the emergency room. Without a primary care physician, with every asthma attack the child is likely to revisit an emergency room. The child will see a different provider, who will treat the asthma attack and then send the patient home.

With access to a medical home, however, a primary care provider has the opportunity to evaluate the severity of the patient’s asthma and prescribe preventative medications to reduce the number of asthma attacks. This has the potential to have a large impact on the child’s health and development as well as decreasing emergency room visits, which are costly to the patient and the health care system.

Unfortunately, many providers feel they simply cannot afford to accept new medicaid patients. Historically, Medicaid payment rates are well below the actual cost of providing care. However, the are things that can be done. There is currently a policy that increases Medicaid payment rates to match Medicare payment rates. This policy, which more closely matches payment rates with the actual cost of care for primary care physicians, has the ability to increase access to primary care physicians for numerous children enrolled in Medicaid.

You can read comments from the AAP regarding this topic here. If you would like to reach out to your local congressman, click here.

by Krista Whitney, MD


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