OBGYNs Face Challenges When Providing Care To Medicaid Members

Obstetrician-gynecologists (OBGYNs) experience reimbursement and referral challenges for care provided to Medicaid beneficiaries, according to a new nationally representative survey of OBGYNs conducted by the Kaiser Family Foundation (KFF).

Medicaid was accepted more often in community health centers and clinics compared to private practices (90%v. 77%). Additionally, the proportion of Medicaid beneficiaries who received care at community health centers was greater than the share of Medicaid members at private practices (46% v. 24%).

Providers at practices that accept Medicaid reported several limitations of this coverage plan. Almost half of providers surveyed noted that Medicaid reimbursement is much less (49%) or somewhat less (41%) than private plans.

Additionally, nearly three in four OBGYNS reported that it was much harder (28%) or somewhat harder (45%) to find specialists who accept Medicaid referrals compared to private insurance coverage. OBGYN providers in non-Medicaid expansion states were more likely to experience specialist referral challenges compared to those in Medicaid expansion states (84% v. 68%).

The majority of OBGYNs said they experienced limitations providing contraceptive care to Medicaid beneficiaries. Specifically, 45 percent had been required to obtain prior authorization for specific contraceptives and 33 percent could only prescribe a 30-day initial supply for some contraception methods.

OBGYNs reported that affordability is a common topic of discussion in patient-provider interactions. Nine in ten OBGYNs said the issue of affordability always (11%), often (42%), or sometimes (38%) comes up when they recommend tests or services to their patients. Seven percent said the topic came up rarely, and one percent said it never came up.

Nearly all OBGYNs acknowledged cost as a reproductive care access barrier, with 55 percent reporting that the cost of reproductive health services poses a significant financial burden on low-income patients. Thirty-seven percent of OBGYNs said that reproductive health services place a minor cost-related barrier for low-income patients, and only seven percent believed it poses no financial burden.  

However, providers were not always aware of the out-of-pocket costs patients would face for services. When giving diagnostic and treatment recommendations to patients, 14 percent of OBGYNs said they were always aware of patients’ out-of-pocket costs. The remaining providers said they were often (39%), sometimes (31%), rarely (13%), or never (2%) aware of the magnitude of out-of-pocket costs their patients would face.

More OBGYNs in states without Medicaid expansion reported that reproductive services pose a major financial burden for low-income patients compared to those in Medicaid expansion states (63% v. 52%).

The survey results showed that the Affordable Care Act’s (ACA) requirement for all private insurance plans to cover prescription contraceptive services and supplies to women without cost-sharing led to increased use of contraceptives.

Since this policy was implemented, 63 percent of OBGYNs reported an increased percentage of their patients using any contraceptive method. OBGYNS in private practices reported greater increased contraceptive use than those working in community health centers (66 percent vs. 47 percent).

While the reported increase in contraceptive use is greater for private practices, this disparity could be because providers in private practices saw more patients with private insurance than those in community health centers (60% v. 28%), meaning that a higher proportion of patients at private practices were eligible for the benefits of the ACA’s contraceptive policy.

Additionally, community health center providers saw a higher share of Medicaid patients already covered for contraceptive services. However, the survey report noted that Medicaid expansion may have provided better access to contraceptive services for formerly uninsured patients at community health centers.