Study: Children With Medicaid More Likely To Be Denied Specialist Care

Children covered by Medicaid are more likely than those covered by private insurers to be denied treatment by medical specialists and to face wait times of more than a month for an appointment, according to a study published Thursday in the New England Journal of Medicine, the New York Times reports (Grady, New York Times, 6/15).

The study was funded by the Illinois Department of Healthcare and Family Services as part of a 2005 consent decree from a class-action lawsuit that alleged that children covered by Medicaid in Cook County, Ill., were not getting equal access to primary care (Tanner, AP/Washington Post, 6/15).

Study Details, Findings

For the study, researchers between January and May 2010 posed as parents of sick or injured children and called 273 specialists in Cook County to schedule appointments. The researchers described urgent problems that were not emergencies, including seizures and uncontrolled asthma, when calling specialists in the following areas:

• Allergy;
• Dermatology,
• Endocrinology;
• Neurology;
• Orthopedics;
• Otolaryngology;
• Psychiatry; and
• Pulmonology (New York Times, 6/15).

The first time they called each clinic, researchers said the child was covered under private insurance. In a second call one month later, researchers said the child was covered by Medicaid. In about 50% of the calls, clinic workers asked about insurance before saying whether an appointment was available.

Overall, 66% of the specialists denied appointments to children covered by Medicaid, compared with 11% of specialists who denied appointments to those covered by private insurance. Eighty-nine clinics accepted both types of insurance, but children covered by Medicaid still had to wait an average of 22 days longer for an appointment than those with private insurance.

Orthopedic doctors were most likely to deny appointments to children covered by Medicaid, while psychiatrists were the least likely. About 20% of clinics that refused appointments referred callers to county hospitals or emergency departments.

Reimbursement Rates Likely a Factor

Researchers said that lower Medicaid reimbursement rates likely are to blame for the disparity.

Many specialists who were told about the study afterwards said that their hospitals or health systems discouraged them from treating too many Medicaid patients for financial reasons (AP/Washington Post, 6/15).

A number of specialists said that they could not continue running their practices if they accepted too many patients covered by Medicaid (New York Times, 6/15).

 According to the study, Medicaid in Illinois will pay about $100 for office visits for problems of "moderate severity," compared with $160 from private insurers (AP/Washington Post, 6/15).