Access of Medicaid Recipients to Outpatient Care

Background: Visits to the emergency department by Medicaid recipients for nonemergency problems are common and contribute to rising health care costs. However, such patients may have few alternatives. We conducted a telephone survey of 953 ambulatory care sites in 10 cities to determine the availability of appointments for Medicaid recipients with common problems.

Methods: Research assistants telephoned all ambulatory care clinics and a stratified sample of private primary care practices in the catchment area served by the hospital emergency department in each city. The assistants identified themselves as Medicaid recipients seeking care for one of three problems (low back pain, dysuria, or sore throat) and asked a standardized series of questions. Data were collected on appointments or walk-in visits authorized at any time, within two days after the call, or after 5 p.m.; copayment requirements; and reasons appointments could not be made. If an appointment was made, it was canceled at the end of each call or shortly thereafter. Several weeks later, private-practice sites in six of the cities were recontacted; the research assistants identified themselves as patients with private insurance and the same problem.

Results: An appointment or an authorization for a walk-in visit was obtained from 418 of the 953 practice sites (44 percent); 47 of the sites (5 percent) could not be contacted. Appointment rates for the different types of sites ranged from 72 percent for free-standing urgent care centers to 34 percent for private practices. "Not accepting Medicaid" was the most common reason given for not granting an appointment or walk-in visit. Only 72 of the sites (8 percent) offered after-hours care within two working days after the call without a cash copayment. Sixty percent of the 330 private practices that were recontacted agreed to see a patient with private insurance within two working days, but only 26 percent agreed to see a patient with Medicaid within two days (P < 0.001).

Conclusions: Medicaid recipients in urban areas have limited access to outpatient care apart from that offered by hospital emergency departments.