By Martha Heberlein

Much of the focus over the last six months has been on connecting folks to coverage. But once that’s been accomplished, the next question that often (rightfully) pops into people’s minds is whether or not these newly-insured consumers will be able to access care.

Scores of studies over the years have consistently found that the type of insurance doesn’t matter all that much – access to primary and preventive care for both children and adults in Medicaid is on par with those with private insurance, and much better when compared to those who are uninsured. In fact, in both public and private coverage more than 95% of children have a usual source of care, as do almost 90% of adults. Additionally, more than 80% of insured children had a well-child visit, compared to less than 40% of those who are uninsured, and similar patterns are seen among adults.

So while we’re pretty confident that established patients fare well, a “secret shopper” (or audit) study from the University of Pennsylvania and the Urban Institute highlights some potential issues for new Medicaid patients seeking a first time appointment.

Looking at ten states (AR, GA, IL, IA, MA, MT, NJ, OR, PA, and TX) callers pretended to be new adult patients seeking a visit with a PCP. Almost 85% of privately insured callers received a new patient appointment, while just 58% of Medicaid callers did. The vast majority of private patients who were unable to secure an appointment were told that the office was not taking new patients, while Medicaid patients were more likely to be told that they weren’t able to get an appointment because of their insurance status.

As for the uninsured, if they were willing to pay full-freight (with the median cost being $120) at the time of the appointment, they were able to secure an appointment 79% of the time. However, just 15% of uninsured callers were able to get an appointment that required a payment of $75 or less at the time of the visit, either because few had low-cost appointments or allowed flexible payment arrangements.

Importantly and regardless of the coverage source – once the callers secured an appointment, the wait time (5-8 days) was the same.

So what does this mean in terms of access to care in Medicaid?

The authors supplemented their study with an issue brief that provides some context on access to care in Medicaid.

Looking at survey data, they found that established low-income Medicaid and privately insured adults had similar levels of primary care access, with the vast majority having a usual source of care and two-thirds having a PCP visit within the last year. Barriers for both groups were relatively rare, but differed based on insurance status – Medicaid enrollees were more likely to experience difficulties getting in with providers, whereas those with private coverage were more likely to experience cost barriers.

They also looked at the experiences of adults who were newly enrolled in Medicaid or private coverage – both of whom were more likely to say that they experienced provider access issues. Importantly though, most new Medicaid enrollees who reported that they had difficulty finding a provider with an available appointment were able to get one.

For newly insured consumers, connecting with a provider is an important next step – yet if fewer practices are offering primary care appointments to new Medicaid enrollees, they are likely to face barriers to doing so. This will be an important issue to keep an eye on as states add newly eligible Medicaid beneficiaries.

Concerns about whether provider capacity can meet the increased demand have been raised more generally and while Medicaid’s low reimbursement makes it a highly efficient program, it does also raise legitimate questions about provider participation. However, there is hope that the primary care bump included in the ACA (even if slow to be implemented!) will help attract additional providers – perhaps helping to make the case for an extension of the increased reimbursement rate beyond the 2013-2014 period.

The new secret shopper study also provides an important look at Medicaid managed care networks, reporting that two-thirds of practices have a contract with a Medicaid managed care plan. If the state is contracting with just a subset of PCPs, patients’ choice of providers is already limited and the providers who are participating need to serve a disproportionate share of the population. As states initiate or renew Medicaid managed care contracts, they should consider how they can expand their provider networks and include stronger minimum network adequacy standards. Additionally, it will be important to identify providers who are accepting new patients and make sure that this information is easily available to consumers.