GAO Report: Medicaid and CHIP Children Have Harder Time Finding Specialty Care

Jul 8, 2011, 11:15 AM, Posted by

A newly released study from the U.S. Government Accountability Office (GAO) finds that children enrolled in Medicaid and the Children’s Health Insurance Program (CHIP) have a much harder time obtaining care from medical specialists than do children who are privately insured.

The GAO based its conclusions on its 2010 survey of physicians. Its key findings:

  • “More than three-quarters of primary and specialty care physicians are enrolled as Medicaid and CHIP providers and serving children in those programs.”
  • “A larger share of primary care physicians (83 percent) are participating in the programs—enrolled as a provider and serving Medicaid and CHIP children—than specialty physicians (71 percent).”

  • “A larger share of rural primary care physicians (94 percent) are participating in the programs than urban primary care physicians (81 percent).”
  • “Nationwide, physicians participating in Medicaid and CHIP are generally more willing to accept privately insured children as new patients than Medicaid and CHIP children. For example, about 79 percent are accepting all privately insured children as new patients, compared to about 47 percent for children in Medicaid and CHIP.”
  • “[M]ore than three times as many participating physicians—84 percent—experience difficulty referring Medicaid and CHIP children to specialty care as experience difficulty referring privately insured children—26 percent. For all children, physicians most frequently cited difficulty with specialty referrals for mental health, dermatology and neurology.”

GAO’s survey also found that physicians who do not participate in Medicaid and CHIP “most commonly cite administrative issues such as low and delayed reimbursement and provider enrollment requirements as limiting their willingness to serve children in these programs.”

What do you think? Are reimbursements too low? Should doctors treat more disadvantaged children, regardless of the economics? Is there a better solution?

This commentary originally appeared on the RWJF Human Capital Blog. The views and opinions expressed here are those of the authors.