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The New Medicaid Under PPACA What Will it Mean for General Internists?

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Abstract

The Patient Protection and Affordable Care Act (ACA) institutionalized Medicaid as a significant and permanent structure in the U.S. health care system. About half of the 32 million Americans expected to gain health insurance coverage under the ACA will be covered under Medicaid. While it is clear general internists will be significantly impacted by Medicaid-related health care reform provisions, its ultimate effect is unclear since these new opportunities also come with some new potential burdens. There are four main areas of impact for general internists to consider: (1) coverage expansions and reimbursement; (2) multiple payers and fragmented coverage; (3) primary care workforce and infrastructure capacity; and (4) delivery model changes.

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References

  1. Ku L. Ready, set, plan, implement: Executing the expansion of Medicaid. Health Aff. 2010;29(6):1173.

    Article  Google Scholar 

  2. Key Questions about Medicaid and its Role in State/Federal Budgets and Health Reform [Internet] Washington DC: The Henry J. Kaiser Family Foundation; c2011 [cited 2011 March 18]. Available from: http://www.kff.org/Medicaid/upload/8139.pdf.

  3. Buettgens M, Holahan J, Carroll C. Health reform across the states: Increased insurance coverage and federal spending on the exchanges and Medicaid. Robert Wood Johnson Foundation: State Coverage Initiatives; 2011.

    Google Scholar 

  4. Primary Care: What is a health center? [Internet]July, 2011]. Available from: http://bphc.hrsa.gov/about/.

  5. Sloan F, Mitchell J, Cromwell J. Physician participation in state Medicaid programs. Journal of Human Resources. 1978;13(suppl):211–45.

    Article  PubMed  Google Scholar 

  6. Hadley J. Physician participation in Medicaid: Evidence from California. Health Serv Res. 1979;14(4):266–80.

    PubMed  CAS  Google Scholar 

  7. Davidson SM. Medicaid reform. Health Soc Work. 1982;7(2):85–7.

    PubMed  CAS  Google Scholar 

  8. Mitchell JB. Physician participation in Medicaid revisited. Medical Care. 1991;29(7):645–53.

    Article  PubMed  CAS  Google Scholar 

  9. Perloff JD, Kletke PR, Fossett JW. Which physicians limit their Medicaid participation and why. Health Services Research. 1995;30(1):7–26.

    PubMed  CAS  Google Scholar 

  10. Fanning T, de Alteris M. The limits of marginal economic incentives in the Medicaid participation among pediatricians. Pediatrics. 1993;72(4):552–59.

    Google Scholar 

  11. Baker LC, Royalty AB. Medicaid policy, physician behavior, and health care for the low-income population. The Journal of Human Resources 2000;XXXV(3):480–502.

    Google Scholar 

  12. Cunningham PJ. Research brief: State variation in primary care physician supply: Implications for health reform Medicaid expansions. Center for Studying Health System Change (HSC), Robert Wood Johnson Foundation; 2011 March 17. Report nr 19.

  13. CHIP Enrollment June 2009: An Update on Current Enrollment and Policy Directions [Internet] Washington DC: The Henry J. Kaiser Family Foundation; c2010 [cited 2011 March 18]. Available from: http://www.kff.org/Medicaid/upload/7642-04.pdf.

  14. Sommers BD, Rosenbaum S. Issues in health reform: How changes in eligibility may move millions back and forth between Medicaid and insurance exchanges. Health Aff Project Hope. 2011;30(2):228–36.

    Article  Google Scholar 

  15. News Release: HHS announces new federal support for states to develop and upgrade Medicaid IT systems and systems for enrollment in state exchanges [Internet]Washington DC: U.S. Department of Health and Human Services; c2011 [cited 2011 March 18]. Available from: http://www.hhs.gov/news/press/2010pres/11/20101103a.html.

  16. Kullgren JT, McLaughlin CG. Beyond affordability: The impact of nonfinancial barriers on access for uninsured adults in three diverse communities. J Community Health. 2010;35(3):240–8.

    Article  PubMed  Google Scholar 

  17. Iglehart JK. Health centers fill critical gap, enjoy support. Health Aff Project Hope. 2010;29(3):343–5.

    Article  Google Scholar 

  18. Rothkopf J, Brookler K, Wadhwa S, Sajovetz M. Medicaid patients seen at federally qualified health centers use hospital services less than those seen by private providers. Health Aff Project Hope. 2011;30(7):1335–42.

    Article  Google Scholar 

  19. Fossett JW, Peterson JA. Physician supply and Medicaid participation the causes of market failure. Med Care. 1989;27(4):386–96.

    Article  PubMed  CAS  Google Scholar 

  20. Adams EK. Effect of increased Medicaid fees on physician participation and enrollee service utilization in Tennesee, 1985–1988. Inquiry. 1995;31(2):173–87.

    Google Scholar 

  21. Summary Of The Health Workforce Provisions In The Patient Protection And Affordable Care Act: H.R. 3590 [Internet] Washington DC: National Conference of State Legislatures; c2010 [cited 2011 March 18]. Available from: http://www.ncsl.org/documents/health/HlthWrkfrceProvHR3590.pdf.

  22. Rieselbach RE, Crouse BJ, Frohna JG. Teaching primary care in community health centers: Addressing the workforce crisis for the underserved. Ann Intern Med. 2010;152(2):118.

    PubMed  Google Scholar 

  23. Kelrsh R. Health reform: The politics of implementation. JHPPL 2011;36(3).

  24. Building Medical Homes in State Medicaid and CHIP Programs [Internet] Washington DC: The National Academy for State Health Policy; c2009 [cited 2011 March 18]. Available from: http://www.nashp.org/sites/default/files/medicalhomesfinal_revised.pdf.

  25. Blue Ribbon Panel of the Society of General Internal Medicine. Redesigning the practice model for general internal medicine a proposal for coordinated care: A policy monograph of the society of general internal medicine. J Gen Intern Med. 2007;22(3):400–9.

    Article  Google Scholar 

  26. Satety Net Medical Home Initiative. Health Reform and the Patient-Centered Medical Home: Policy Provisions and Expectations of the Patient Protection and Affordable Care Act [Internet] Seattle, WA: Qualis Health and Bailit Health Purchasing; c2010 [cited 2011 March 18]. Available from: http://www.qhmedicalhome.org/safety-net/upload/SNMHI_PolicyBrief_Issue2.pdf.

  27. Nutting PA, Crabtree BF, Miller WL, Stange KC, Stewart E, Jaén C. Transforming physician practices to patient-centered medical homes: Lessons from the national demonstration project. Health Aff Project Hope. 2011;30(3):439–45.

    Article  Google Scholar 

  28. Grogan C. M. In Morone J., Litman T. and Robins L. (Eds.), Medicaid: Health care for you and me!. (2nd Edition) New York: Delmar Thompson. 2012 (forthcoming).

  29. Thompson F. The medicaid platform: Can the termites be kept at bay? Journal of Health, Politics, Policy and Law. 2011;36(3).

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Acknowledgements

I would like to acknowledge the helpful comments and feedback of JGIM Editor Caleb Alexander and two anonymous reviewers.

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None disclosed.

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Correspondence to Colleen M. Grogan PhD.

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Grogan, C.M. The New Medicaid Under PPACA What Will it Mean for General Internists?. J GEN INTERN MED 26, 1502–1505 (2011). https://doi.org/10.1007/s11606-011-1856-9

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  • DOI: https://doi.org/10.1007/s11606-011-1856-9

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