Studies: Current Medicaid Beneficiaries May Miss Out on ACA Benefits

Although millions of low-income U.S. residents are expected to gain coverage under the Medicaid expansion in the Affordable Care Act, some beneficiaries already enrolled in the program might miss out on the preventive services included in the ACA, according to a pair of studies published Monday in Health Affairs, Politico reports.

Few States Offer Preventive Services at ACA Levels

A study by George Washington University researchers Sara Wilensky and Elizabeth Gray found that the ACA does not require Medicaid to cover preventive services for individuals who already are eligible for the program (Millman, Politico, 7/9).

Currently, Maine and Nevada are the only states that offer all of the preventive services available under the ACA's Medicaid expansion to current beneficiaries, according to the report.

The report also found that:

• 12 states do not cover preventive check-up appointments;
• Four states offer checkups only to beneficiaries in Medicaid managed care plans;
• Fewer than 20 states cover screenings for cholesterol, obesity, depression, diabetes and blood pressure;
• Five states do not cover colorectal cancer screenings;
• Just 11 states require counseling about using aspirin to reduce heart attack and stroke risk; and
• Only 10 states cover osteoporosis screenings (Adams, CQ HealthBeat, 7/8).

The ACA does include a 1% reimbursement increase for states that expand preventive services for current Medicaid beneficiaries (Politico, 7/9). However, most state officials interviewed by Wilensky and Gray said they were unaware of that incentive (CQ HealthBeat, 7/8).

Finding Providers Might Be Difficult

A separate study by Sandra Decker of the National Center for Health Statistics found that Medicaid beneficiaries might have difficulty finding a provider.

The study found that nearly one-third of physicians did not accept new patients with Medicaid coverage in 2011 and 2012. Medicaid typically reimburses less than private insurance or Medicare coverage.

In particular, beneficiaries had the hardest time finding a primary care provider in:

• Alabama;
• California;
• Michigan; and
• New Jersey.

Dermatologists, internists and psychiatrists were the least likely to accept new patients with Medicaid, according to the study.

Decker noted that a temporary two-year increase to Medicaid reimbursements included in the ACA might not be enough to draw more primary care providers into the program (Politico, 7/9).