Bipartisan Policy Center Releases Recommendations to Advance Comprehensive Primary Care in Medicaid

WASHINGTON, July 8 -- The Bipartisan Policy Center issued the following news release:

An estimated 74 million low-income Americans are enrolled in Medicaid; however, many of these individuals don't have access to comprehensive primary care services, which can improve health outcomes and mitigate costly medical care, while reducing disparities. A new report released by the Bipartisan Policy Center addresses the federal policy barriers that limit advancing effective comprehensive primary care services in the United States. It also provides recommendations that would support a strong framework for improving primary care services; improve access to affordable health insurance coverage and services; strengthen the primary care workforce; and target the racial, ethnic, and economic disparities in the Medicaid program.

Nearly half of adults with Medicaid are age 50 or older and many have multiple chronic conditions, behavioral health needs, physical limitations, or disabilities. Compared to low-income privately insured individuals, the Medicaid population is sicker and has more disabilities. But as the report explains, Medicaid coverage alone does not guarantee access to comprehensive primary care.

"Medicaid is the primary source of coverage for millions of low-income and vulnerable Americans, yet many beneficiaries still lack a relationship with a primary care doctor," said BPC Health Policy Director Katherine Hayes. "When low-income adults have both health insurance and access to a regular care provider that delivers patient-centered care, they are less likely to report cost-related access problems. They are also more likely to be up-to-date with preventive screenings, report greater satisfaction with the quality of their care, and stay healthier."

Medicaid beneficiaries, when compared to privately insured individuals, find it harder to access primary care in a timely fashion, making them more likely to utilize emergency departments as a source of care. According to primary care providers participating in Medicaid managed care plans, current policies present challenges to meeting patients' needs and some policies are detrimental to outcomes and quality of care.

For example, barriers that prevent a robust primary care workforce within the Medicaid program include low provider reimbursement rates, lack of data-driven network adequacy requirements in managed care, and limited workforce capacity. BPC recommends increasing reimbursement rates for primary care providers, strengthening network adequacy requirements, reauthorizing federal funding for safety-net programs, increasing oversight and coordination of workforce programs, as well as expanding the number of J-1 visas for foreign doctors and revising restrictions for H-1B visas to close the workforce shortage gap.

As COVID-19 spreads and spikes across the country, millions of people are now applying for Medicaid since losing their jobs due to the economic downturn. Thirteen states, however, have declined to adopt Medicaid expansion, leaving approximately 5 million low-income people ineligible for assistance.

To expand access to affordable health insurance coverage, BPC recommends Congress reopen the option for states to participate in Medicaid expansion and receive increased federal funding to help support this newly eligible population. States that have not expanded Medicaid would also have the option to partially expand at a federal match rate that is lower than the one offered under traditional expansion. Additionally, Congress should allow states to auto-enroll and provide 12-month continuous coverage to low-income individuals, who often experience fluctuations in income, to avoid gaps in coverage and disruptions in care.

"COVID-19 has exposed the barriers to comprehensive primary care across our nation's health care system," added Hayes. "To improve the health of low-income Americans both now and after the pandemic, a comprehensive approach to primary care is critical in Medicaid."

Barriers to expanding comprehensive primary care models include misalignment of payment and delivery models, including financial incentives and state policy, and managed care contracts that do not promote innovation in primary care. Additionally, many primary care practices lack the time and resources necessary for implementing innovative programs.

BPC's report recommends Congress elevate primary care as a priority for Medicaid, support sharing of best practices and innovations among states, appropriate funding for the Primary Care Extension Program, and promote measurement and reporting of spending on primary care.

To address disparities impacting economic, racial, and ethnic groups within the Medicaid program, BPC recommends that Congress block the implementation of a new rule finalized by the Trump administration that reverses protections for non-English speaking Americans and protections against sex discrimination in the health care system. It also encourages reimbursement of community health workers, monitoring and enforcement mechanisms for ensuring nondiscrimination for individuals with disabilities, and coverage of cost-effective interventions to address social needs for high-risk populations.

"Access to primary care can help individuals live longer, help avoid or delay the onset of costly chronic conditions such as diabetes, heart disease, and cancer and help reduce more expensive ER care," said Hayes. "As health care policymakers seek to move away from volume-driven fee-for-service health care toward better integrated systems of care, we hope these recommendations provide a roadmap for promoting primary care across all health programs and payers. Failure to address the lack of good primary care in the United States will lead to even higher federal costs in Medicaid over time."