The state of Indiana hopes it will have enough providers to handle hundreds of thousands of new Medicaid patients if its expansion plan is approved by the federal government.
The feds are currently evaluating whether to grant the state a waiver to implement the Healthy Indiana Plan 2.0, which would expand Medicaid to people earning up to 138 percent of the federal poverty level, part of the Affordable Care Act. But it requires recipients to put a set amount of money each month into a health savings account to pay for their care. HIP 2.0 would expand coverage to an estimated 350,000 Hoosiers.
But not all doctors accept Medicaid patients, for reasons ranging from the low reimbursement rates to the complex health needs of many of the program's beneficiaries.
"Coverage doesn't equal access," said Joe Moser, director of Medicaid for Indiana, pointing out that nearly 20 percent of physicians across the state don't participate in the program. Compared to other states, Indiana had an "average" number of primary care doctors accepting new Medicaid patients in 2011-2012, according to a study by the Urban Institute.
One common reason doctors don't take Medicaid is the low fee schedule, which often barely covers the cost of care.
To get more doctors to accept beneficiaries of the original Healthy Indiana Plan, the state pays them at the Medicare reimbursement rate, which is higher than that of Medicaid. The state says this has allowed the managed care companies that operate the program to recruit more physicians into their networks. The enhanced rates would remain in place under HIP 2.0. The state is also proposing a 25 percent increase in reimbursement for traditional Medicaid, which is largely for children, pregnant women and the disabled and does not require any payment.
Another reason doctors choose not to participate in Medicaid is the administrative headaches associated with the program.
"There's a regulatory burden with participating in Medicaid, as far as enrolling as a provider, the paperwork that goes along with that," Moser said. "We always seek to reduce unnecessary paperwork and streamline the enrollment process."
In an effort to meet the demand of all the newly insured Americans created by the Affordable Care Act, the 2010 law included $11 billion to expand the nation's community health centers.
Take Valparaiso-based HealthLinc. In 2002, it had an operating budget of $340,000, which came from the state; now, it has an annual budget of roughly $23 million.
Its recently revamped flagship clinic in Valparaiso, built with a $5 million federal grant, is likely not the vision many people have in their heads of a safety-net clinic (in fact, many patients don't even realize it is one). It sparkles brighter than many private doctor's offices; it includes a medical center, dental services, vision care, a pharmacy and a community room.
"A lot of people think, 'I have to go to a community health center. It's going to be dirty and dingy,'" noted HealthLinc CEO Beth Wrobel.
On a recent day, the large waiting room was only partly filled, an indication the center has the capacity to see many more patients.
Dr. Janet Seabrook, executive director of Gary-based Community Healthnet, said her health center is also poised to handle patients who gain insurance under HIP 2.0. Many of those people are already clients of the clinic, which sees patients regardless of their insurance status.
"Our health center will be able to accept new patients and the newly insured through the Healthy Indiana Plan 2.0 without causing any interruptions or delays in service," she said, noting that the clinic is actually bringing on two additional providers in the coming weeks.
Parts of the region do have a dearth of physicians, though. According to the U.S. Department of Health and Human Services, the low-income population of Gary has a shortage of primary care doctors; East Chicago has a deficiency of dentists; and the city of Gary and northwest Lake County have shortages of mental health care providers.
HHS also designates Gary, East Chicago, Lake Station, central Hammond, the low-income population of Porter County and all of LaPorte County as being medically underserved. That designation means an area has too few primary care doctors to go along with high rates of infant mortality, poverty and/or elderly residents.