New Medicaid patients could test state’s physician network

Connecticut stands to see its Medicaid patient caseload surge starting in 2014 as national health care legislation opens the door to as many as 150,000 new patients over a six-year period, according to a new study.

And while there would be new federal funding to cover much of the added cost, there’s no guarantee that patients will be able to find doctors unless state government moves now to reverse a dangerous shortage in primary care providers, health care advocates and one key state lawmaker said Thursday

“Our provider networks are simply not large enough to handle it,” said Ellen Andrews, executive director of The Connecticut Health Policy Project, a New Haven-based, nonprofit health care advocacy group. “Doctors are going to get inundated with phone calls and many people are not going to have access to health care unless we act now. You can’t grow doctors overnight.”

Andrews was reacting to a recent analysis of the federal Patient Protection and Affordable Care Act adopted in May, which opens Medicaid-funded state health coverage to single, childless adults who earn less than 133 percent of the federal poverty level. According to the Center on Medicare and Medicaid Services, that would mean an individual earning less than $14,403 this year.

The analysis prepared by The Urban Institute, a Washington, D.C.-based, nonpartisan economic and social policy research group, estimated Connecticut’s annual Medicaid caseload would grow – solely due to new enrollees eligible because of this legislation – between 114,083 and 154,664.

Much of this growth would appear in 2014, when the new requirement takes effect, and would be fully realized by 2019.

Those growth numbers represent a range between 22 and 30 percent of the current Medicaid-funded health care caseload, excluding elderly patients in nursing homes.

According to state Department of Social Services spokesman David Dearborn, Connecticut provides health care to about 249,000 children and 130,000 adults through the Medicaid-funded portion of the Husky program. Nearly 45,000 unemployed, single adults without children receive health benefits through General Assistance. And another 90,000 disabled and low-income elderly residents receive assistance through what is commonly called the “fee for service” system, one of the oldest state Medicaid programs that reimburse physicians based on each treatment or service they provide.

Connecticut’s network of primary care physicians – pediatricians, family practitioners and internists – already is stretched to its limit, Andrews said, adding that was badly exposed in 2008 when Gov. M. Jodi Rell’s Charter Oak Health Program – a state-funded program that provides health coverage to poor adults at group rates – was launched. Insurance companies competing to administer Charter Oak and Husky struggled to find a sufficient number of doctors willing to treat patients from these two programs.

The Connecticut State Medical Society, the state’s largest physicians’ organization with more than 7,300 members, released a workforce study last year that argued Connecticut’s primary-care capacity was stretched thin.

The report found 74 percent of family practitioners and 72 percent of internists in Connecticut were accepting new patients.

But it also found wide variances in access to primary care physicians on a county-by county basis. The percentage of all primary care physicians accepting new patients in Windham and Tolland counties was just 37.5 percent and 50 percent, respectively, while in Fairfield and New London counties it was 85 and 87 percent.

Audrey Honig Geragosian, spokeswoman for the society and one of the authors of the 2009 study, agreed with Andrews that Connecticut has a relatively short time frame to prepare for a huge influx of patients. “Guaranteeing health coverage is not the same as providing access to care,” she said.

The state legislature and Rell approved a series of rate increases in 2007 for physicians who treat Medicaid patients, but many of the categories that received increases had not been adjusted in more than a decade.

Geragosian also said reimbursement rates, though important, are just one consideration.

Doctors remain wary of Connecticut, she said, because state officials have largely ignored a distorted medical malpractice system that has resulted in some of the highest insurance premiums in the country.

And with about 86 percent of this state’s physicians in small practices with four members or fewer, the high cost is too burdensome for many, Geragosian said. “Imagine you are a small business and every year you have to shell out tens of thousands of dollars before you can see a single patient,” she added. “Connecticut remains one of the crisis states in terms of medical malpractice. We’ve got a reputation.”

The medical society also remains concerned about the ongoing consolidation of the health insurance industry, a trend that leaves doctors with fewer and fewer insurance networks to negotiate with, Geragosian said. That lack of competition gives companies considerable leverage to pay rates that are not competitive with those available outside of Connecticut, particularly given the higher cost of doing business here, she said.

State Sen. Jonathan Harris, D-West Hartford, co-chairman of the legislature’s Public Health Committee, said that in addition to addressing factors that weaken Connecticut’s competitive edge in attracting and retaining doctors, the state needs to act now to begin producing more primary care physicians from its universities and colleges.

That should mean new financial incentives being offered, but not just to students, Harris said.

Though tuition waivers and low-interest loans for students are a good idea, “we have to take a look outside of the box and look at putting requirements on our medical schools themselves,” Harris said.

The West Hartford lawmaker said he’s open to exploring offering the University of Connecticut Health Center in Farmington added funding if it graduates more pediatricians, family practitioners and internists. That could require the center to overhaul its curriculum, develop other programs to attract medical students interested in this type of practice, and even begin screening applications more closely to target the right applicants.

“If they can’t grow these doctors that we need, then they might lose out on some funding,” Harris said. “This is the type of problem that if you don’t get your arms around it soon, then later you’re definitely going to be behind the eight ball.”

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