Everyone deserves access to quality health care. To ensure low-income patients enrolled in Medicaid receive needed care, the AMA works diligently at the state and federal levels to improve Medicaid programs, expand coverage options and make it easier for physicians to see Medicaid patients.

Access to care

Obtaining health insurance does not necessarily ensure better access to health care. Too often Medicaid patients face barriers to care, resulting in more frequent emergency department visits, delayed treatment of chronic conditions and poorer health outcomes.

Research demonstrates that low Medicaid reimbursement rates significantly affect a physician’s ability to accept new Medicaid patients. Physicians have a strong sense of responsibility to provide care for Medicaid patients, but cannot remain economically viable if they lose money on the care they provide. Without enough participating physicians, patients may have coverage but not real access to care.

To expand access to care, the AMA works with state advocates to fully fund the Medicaid program and increase physician participation with policies to streamline enrollment, ensure fair audit procedures and improve managed care programs.

Expanding coverage

To date, 31 states and the District of Columbia have expanded Medicaid coverage under the Affordable Care Act (ACA) to individuals with incomes up to 133% of the federal poverty level. Since this change, states have enrolled over 14.5 million new people into Medicaid, bringing total enrollment to nearly 72 million people nationwide.

The AMA works with advocates and policymakers at all levels of government to identify realistic coverage options for the uninsured and supports expansion plans that best meet the needs and priorities of states and low-income patients.

In many states, policymakers are testing new ways to serve the Medicaid population. Reform efforts must ensure that Medicaid is a viable and effective program to provide health insurance coverage to low-income individuals, seniors and the disabled. Changes in the financing of Medicaid should not undermine the overall coverage gains that have occurred under the ACA, particularly for individuals with the lowest income.

Issue briefs

PDF 1: Issue Brief: Medicaid Access Rule

PDF 2: Issue Brief: Medicaid Expansion Demonstration Waivers

PDF 3: Issue Brief: Medicaid delivery and payment reform

PDF 4: Issue Brief: Medicaid Managed Care Final Rule

Model legislation

PDF 5: Model Bill: Streamlined Medicaid enrollment process for ordering and referring physicians

PDF 6: Model Bill: Prohibiting mandatory physician participation in health programs

PDF 7: Model Bill: Medicaid coverage of the National Diabetes Prevention Program

Other resources

PDF 8: Medicaid expansion decisions by state

PDF 9: Research summary: Medicaid physician reimbursement

PDF 10: State advocacy roadmap: Medicaid access to care

PDF 11: Research summary: Benefits of Medicaid expansion

Links

LINK 1: Letter to CMS concerning Medicaid access

LINK 2: Letter to CMS concerning Medicaid managed care

LINK 3: View AMA policies related to Medicaid in PolicyFinder

LINK 4: Find reports from the Council on Medical Service related to Medicaid

Everyone deserves access to quality health care. To ensure low-income patients enrolled in Medicaid receive needed care, the AMA works diligently at the state and federal levels to improve Medicaid programs, expand coverage options and make it easier for physicians to see Medicaid patients.

Access to care

Obtaining health insurance does not necessarily ensure better access to health care. Too often Medicaid patients face barriers to care, resulting in more frequent emergency department visits, delayed treatment of chronic conditions and poorer health outcomes.

Research demonstrates that low Medicaid reimbursement rates significantly affect a physician’s ability to accept new Medicaid patients. Physicians have a strong sense of responsibility to provide care for Medicaid patients, but cannot remain economically viable if they lose money on the care they provide. Without enough participating physicians, patients may have coverage but not real access to care.

To expand access to care, the AMA works with state advocates to fully fund the Medicaid program and increase physician participation with policies to streamline enrollment, ensure fair audit procedures and improve managed care programs.

Expanding coverage

To date, 31 states and the District of Columbia have expanded Medicaid coverage under the Affordable Care Act (ACA) to individuals with incomes up to 133% of the federal poverty level. Since this change, states have enrolled over 14.5 million new people into Medicaid, bringing total enrollment to nearly 72 million people nationwide.

The AMA works with advocates and policymakers at all levels of government to identify realistic coverage options for the uninsured and supports expansion plans that best meet the needs and priorities of states and low-income patients.

In many states, policymakers are testing new ways to serve the Medicaid population. Reform efforts must ensure that Medicaid is a viable and effective program to provide health insurance coverage to low-income individuals, seniors and the disabled. Changes in the financing of Medicaid should not undermine the overall coverage gains that have occurred under the ACA, particularly for individuals with the lowest income.

Issue briefs

PDF 1: Issue Brief: Medicaid Access Rule

PDF 2: Issue Brief: Medicaid Expansion Demonstration Waivers

PDF 3: Issue Brief: Medicaid delivery and payment reform

PDF 4: Issue Brief: Medicaid Managed Care Final Rule

Model legislation

PDF 5: Model Bill: Streamlined Medicaid enrollment process for ordering and referring physicians

PDF 6: Model Bill: Prohibiting mandatory physician participation in health programs

PDF 7: Model Bill: Medicaid coverage of the National Diabetes Prevention Program

Other resources

PDF 8: Medicaid expansion decisions by state

PDF 9: Research summary: Medicaid physician reimbursement

PDF 10: State advocacy roadmap: Medicaid access to care

PDF 11: Research summary: Benefits of Medicaid expansion

Links

LINK 1: Letter to CMS concerning Medicaid access

LINK 2: Letter to CMS concerning Medicaid managed care

LINK 3: View AMA policies related to Medicaid in PolicyFinder

LINK 4: Find reports from the Council on Medical Service related to Medicaid

Why Join the AMA?

An AMA student memberships means you receive exclusive access to the AMA Residency & Fellowship Database® – FREIDA Online® – which lets you search for a residency or fellowship from more than 10,000 programs.

Join Now

For state advocacy issues, please contact:

Annalia Michelman

Senior Legislative Attorney

[email protected]

For federal advocacy issues, please contact:

Debra Cohn

Senior Washington Counsel

[email protected]

Why Join the AMA?

An AMA student memberships means you receive exclusive access to the AMA Residency & Fellowship Database® – FREIDA Online® – which lets you search for a residency or fellowship from more than 10,000 programs.

Join Now