George Washington U. Researchers Track Medicaid Provider Shortages

Aug. 3, 2023
Tracking tool puts a spotlight on regions of the country that suffer from a shortage of primary care providers who accept Medicaid payment for patients

Researchers at the George Washington University in Washington, D.C., have launched an interactive online tracking system that identifies states and counties in the United States that suffer from a shortage of primary care providers who see Medicaid patients.

Previous research has demonstrated that only 68 percent of family physicians accept new Medicaid patients. Other studies have shown gaps in the types of providers who participate in the Medicaid program, but the research on where the gaps are is limited.

“We know that many providers do not accept Medicaid because reimbursement is low and the administrative burden is high. But ultimately this is a practice that puts profits ahead of patients,” said Patricia (Polly) Pittman, the director of the GW Fitzhugh Mullan Institute for Health Workforce Equity, in a statement. “We have to find a way to entice these providers back to Medicaid.”

Pittman and her colleagues developed the Medicaid Primary Workforce Tracker using national data to identify primary care providers with Medicaid claims between 2016 to 2019. The tracker reports the number of Medicaid providers to population ratio and the percentage of all active providers who saw Medicaid patients at state and county levels.

The online tool looks at the contribution of providers offering crucial primary care services. The tracker also puts a spotlight on parts of the state or counties that suffer from a shortage of certain kinds of Medicaid providers, forcing patients to travel long distances to get to a provider. In other cases, the barriers to care can lead to dangerous delays in care, the researchers said.

The Tracker reveals some encouraging, and some alarming, news for Medicaid patients across the nation:

In 2019, the percent of primary care physicians who provided any appreciable care to Medicaid patients - seeing just 11 or more patients over the year – ranged from 84 percent in Wisconsin to as low as 61 percent in New Jersey, suggesting the variability in state Medicaid policy matters in terms of access to care.

Overall, the number of any type of primary care provider who saw Medicaid patients rose 13 percent from 2016 to 2019. However, advanced practice nurses and physician assistants made up 95 percent of the increase.

The number of OB/GYNs seeing Medicaid patients actually dropped 2.5 percent over the 3-year period, with 24 states losing OB/GYNs who accepted Medicaid over this period. Nearly 44 percent of U.S. counties had no Medicaid OB/GYNs at all, a worrisome sign given the importance of this kind of primary care for maternal and child health.

Thirteen states also saw a loss of Medicaid Family Medicine physicians, 21 states saw a loss of Medicaid Internal Medicine Physicians, and 11 states saw a loss of Medicaid Pediatricians.

The Tracker will allow state, local and federal policymakers to identify areas with major deficiencies in providers willing to see Medicaid patients. Even more crucially, the tool allows policymakers to make targeted investments to strengthen the Medicaid workforce and improve access for patients.

While the tracker currently examines data from 2016-2019, the team plans to continue to update the tool as more data becomes available.

An analysis using the Tracker was published Aug. 2 in the Forefront section of the journal Health Affairs by Pittman, Candice Chen and other researchers.