Measuring Medicaid Physician Participation Rates & Implications for Policy

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Measuring Medicaid Physician Participation Rates & Implications for Policy

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Title: Measuring Medicaid Physician Participation Rates & Implications for Policy
Author: Sommers, Benjamin Daniel; Kronick, Richard

Note: Order does not necessarily reflect citation order of authors.

Citation: Sommers, Benjamin D. and Richard Kronick. 2015. Measuring Medicaid Physician Participation Rates & Implications for Policy. Journal of Health Politics, Policy and Law 41 (2): 211-224.
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Abstract: Policymakers continue to debate Medicaid expansion under the ACA, and concerns remain about low provider participation in the program. However, there has been little research on how various measures of physician participation may reflect different elements of capacity for care within the Medicaid program, and how these distinct measures correlate with one another across states. Our objective was to describe several alternative measures of provider participation in Medicaid using recently publicly available data; to compare state rankings across these different metrics; and to discuss potential advantages and disadvantages of each measure for research and policy purposes. Overall, we find that Medicaid participation as measured by raw percentages of physicians taking new Medicaid patients is only weakly correlated with population-based measures that account for both participation rates and the numbers of physicians per capita or physicians per Medicaid beneficiary. Participation rates for all physicians versus primary care physicians also offer different information about state-level provider capacity. Policymakers should consider multiple dimensions of provider access in assessing policy options in Medicaid, and further research is needed to evaluate the linkages between these provider-based measures and beneficiaries’ perceptions of access to care in the program.
Published Version: 10.1215/03616878-3476117
Terms of Use: This article is made available under the terms and conditions applicable to Open Access Policy Articles, as set forth at
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