NEJM: Integrated smart growth needed for Medicaid expansion
Under the Patient Protection & Affordable Care Act (PPACA), the Medicaid eligibility threshold for nonelderly adults will rise to 133 percent of the federal poverty level (about $30,000 for a family of four) in 2014, according to a perspective published online Jan. 26 in the New England Journal of Medicine.
Leighton Ku, PhD, MPH, of the department of health policy at George Washington University in Washington, D.C., and colleagues sought to examine the potential gaps between Medicaid demand and capacity by computing measures of potential Medicaid expansion and current primary care in each state and the District of Columbia.
To determine the size of each state’s Medicaid expansion, the researchers calculated the number of nonelderly adults who, according to census data for 2008–2009, are uninsured and eligible under the 2014 Medicaid criteria and who, according to estimates from the Urban Institute, might enroll in Medicaid under the PPACA.
To determine each state’s primary care capacity, the authors calculated the number of primary care providers (physicians in general, family, or internal medicine, pediatrics, or obstetrics–gynecology as of late 2008, plus adjusted estimates for nurse practitioners and physician assistants) and the number of patients who were served at federally qualified health centers (FQHCs) in 2009.
Using composite “Medicaid expansion” and a “primary care capacity” index, an access-challenge index was created, by dividing the Medicaid expansion index by the primary care capacity index; setting this index to average 100. “States with access-challenge scores exceeding 100 have higher-than-average Medicaid expansions relative to their current primary care capacity, so they will face a larger challenge,” wrote the authors.
Eight states—Oklahoma (212.6), Georgia (190.7), Texas (187.1), Louisiana (177.5), Arkansas (158.6), Nevada (154.3), North Carolina (144.5) and Kentucky (140.4)—are expected to have large Medicaid expansions yet now have weak primary care capacity, according to the authors. “In the absence of additional efforts, the demand for care by newly insured patients could outstrip the supply of primary care providers in these states.”
Seventeen other states with access-challenge scores above 100, most of which are in the South or the Midwest, could also face problems.
At the other end of the scale, Massachusetts (15.2), Vermont (17), the District of Columbia (28.1), Maine (37.2), New York (43.4), Rhode Island (46) and Connecticut (48.8) had scores below 50, indicating that they have greater capacity relative to the size of their expansions, the researchers found.
Leighton Ku, PhD, MPH, of the department of health policy at George Washington University in Washington, D.C., and colleagues sought to examine the potential gaps between Medicaid demand and capacity by computing measures of potential Medicaid expansion and current primary care in each state and the District of Columbia.
To determine the size of each state’s Medicaid expansion, the researchers calculated the number of nonelderly adults who, according to census data for 2008–2009, are uninsured and eligible under the 2014 Medicaid criteria and who, according to estimates from the Urban Institute, might enroll in Medicaid under the PPACA.
To determine each state’s primary care capacity, the authors calculated the number of primary care providers (physicians in general, family, or internal medicine, pediatrics, or obstetrics–gynecology as of late 2008, plus adjusted estimates for nurse practitioners and physician assistants) and the number of patients who were served at federally qualified health centers (FQHCs) in 2009.
Using composite “Medicaid expansion” and a “primary care capacity” index, an access-challenge index was created, by dividing the Medicaid expansion index by the primary care capacity index; setting this index to average 100. “States with access-challenge scores exceeding 100 have higher-than-average Medicaid expansions relative to their current primary care capacity, so they will face a larger challenge,” wrote the authors.
Eight states—Oklahoma (212.6), Georgia (190.7), Texas (187.1), Louisiana (177.5), Arkansas (158.6), Nevada (154.3), North Carolina (144.5) and Kentucky (140.4)—are expected to have large Medicaid expansions yet now have weak primary care capacity, according to the authors. “In the absence of additional efforts, the demand for care by newly insured patients could outstrip the supply of primary care providers in these states.”
Seventeen other states with access-challenge scores above 100, most of which are in the South or the Midwest, could also face problems.
At the other end of the scale, Massachusetts (15.2), Vermont (17), the District of Columbia (28.1), Maine (37.2), New York (43.4), Rhode Island (46) and Connecticut (48.8) had scores below 50, indicating that they have greater capacity relative to the size of their expansions, the researchers found.