Doctors less welcoming of children on Medicaid, GAO finds

Introduction

Low-income children relying on Medicaid or other government-funded health care have much more trouble finding a new doctor than children with private insurance, according to a Government Accountability Office report.

That difficulty is amplified when it comes to specialty care, particularly mental health, dermatology and neurology.

More than three-quarters of 932 doctors surveyed by the GAO reported having difficulty referring children with public insurance for specialty care, citing an overall shortage of specialists, and, in some cases, different waiting lists for children receiving Medicaid or Children’s Health Insurance Program (CHIP) benefits than children with private insurance.

In 2010, more than 40 million children in the country received health care through one of the two government programs. That care cost $79 billion in federal and state funds in 2009, the most recent year for which information is available.

The report estimated that 22 percent of all doctors don’t participate in Medicaid or CHIP.

Among participating doctors surveyed, only half accepted all children in Medicaid or CHIP as new patients, while 80 percent of those doctors accepted all children with private insurance. Nearly 10 percent of those doctors didn’t accept any new child patients on Medicaid or CHIP, citing low reimbursement rates and billing hassles as the two biggest reasons for not participating.

Doctors in rural areas were more likely to accept new patients with Medicaid and CHIP than doctors in urban areas, according to the survey, but rural primary care doctors experienced more difficulty referring their Medicaid and CHIP patients to specialists than their urban counterparts.

Once enrolled, children with Medicaid and CHIP were treated roughly the same by doctor’s offices as children with private insurance, with comparable wait times.

GAO fielded the survey from August 2010 through October 2010. Names were selected from the American Medical Association’s Physician Masterfile. GAO sent the survey to 2,642 doctors and got 932 responses.

FAST FACT: More than 20 percent of doctors don’t participate in Medicaid or the Children’s Health Insurance Program, according to the GAO survey. That number is higher among specialists, 29 percent of whom don’t participate in the public health insurance programs for low-income patients.