Children on Medicaid Turned Away in Illinois

AP PHOTO/DAMIAN DOVARGANES

A study in The New England Journal of Medicine found that 65 percent of children covered by CHIP might be refused appointments in Illinois.

Children on Medicaid have less access to specialty physicians than their privately insured peers, researchers reported on Thursday.

Researchers posing as mothers of children insured by Illinois’ Medicaid-Children’s Health Insurance Program, or CHIP, were turned away from doctor's offices 65.6 percent of the time, compared with only 10 percent of the time if they claimed to have Blue Cross and Blue Shield insurance, the researchers found.

The study, published in The New England Journal of Medicine, confirms what patients and experts alike have long suspected -- many doctors are unwilling to treat patients covered by public insurance.

"We found disturbing disparities in specialty physicians' willingness to provide outpatient care for children with public insurance -- even those with urgent and severe health problems," Dr. Karin Rhodes of the University of Pennsylvania, who led the study, said in a statement. "This study shows a failure to care for our most vulnerable children."

Congress is fighting over the best way to cut health care costs and to get people insured. The signature health reform law passed by a Democratic-led Congress and signed into law by President Obama aims to extend coverage to 32 million people, partly by expanding Medicaid. But, for years, patients have complained that they can't find doctors willing to take new patients with Medicaid and Medicare coverage.

For the study, researchers posing as mothers called 273 specialists around Cook County, Illinois, seeking treatment for conditions as serious as uncontrolled asthma and new-onset seizures.

But even children suffering from epilepsy had just a 46 percent chance of seeing a neurologist. And Medicaid patients granted an appointment with a specialist were scheduled 22 days later, on average, than privately insured children.

Illinois is the first state to audit its specialists, and the findings reveal what anecdotal evidence has long assumed. Medicaid’s low compensation, complicated paperwork, and delayed reimbursements are disincentives to doctors, particularly specialists and others practicing in small private offices, Rhodes said.

 More than half of the receptionists asked for details of insurance coverage first, sometimes explicitly refusing an appointment right away if a "mother" said she had CHIP coverage. It’s easy to see why: Medicaid-CHIP pays $99.36, on average, for an office consultation in Illinois; private insurance would pay $160.

“The key take-home message is that every state needs to study its access,” Rhodes said in a telephone interview. “Otherwise, the disparities will continue and we’ll be blindsided to that. It’s very ethical to test the system, and I’m saying, ‘Here’s a model to use.’ ”

Orthopedists and psychiatrists were the most likely to refuse to see Medicaid patients, the researchers found; they refused appointments more than 80 percent of the time.