Primary Care Physician Restrictions Associated with Medicaid Programs

Managed care has long been a key aspect of the Medicaid system. For many patients, the managed care of their health benefits often comes with some degree of dissatisfaction. Desiring to seek medical attention from any healthcare provider, the Medicaid programs limit access to healthcare to only those physicians authorized to provide such services to Medicaid recipients.

Going one step further, many states have now enacted Medicaid requirements that limit the medical care to the choice of a primary care physician. This model of healthcare delivery is similar to that of the HMO plans that have been under scrutiny in the United States for many years.

Why does the Medicaid program require limited access to a gatekeeper or primary care physician? Because Medicaid requires the healthcare professional to accept the payment in full, many healthcare professionals simply choose not to participate in the Medicaid plans. Because medical providers are limited, the access to healthcare is limited and, as a result, must be filtered to the select few who will accept the Medicaid reimbursement as a full payment.

To compound this complication in participating providers, the Medicaid system has now witnessed an influx of patients who seek medical attention in the emergency room or other acute care facilities. With dissatisfaction at the number of physicians who are participating in the Medicaid plans, limiting access to healthcare, some Medicaid recipients simply consider the emergency room as a viable option to avoid primary physician access.

As with HMO plans, Medicaid recipients simply desire the ability to choose their own physician, including selection of specialty providers. Unfortunately, the establishment of Medicaid, today, does not provide for self selection and, as a result, many patients simply forego primary care physicians altogether.