December 18, 2024
Medicaid Patients in States with Relatively Higher Medicaid Reimbursement Are More Likely to Receive Imaging
Reston, VA – A new Harvey L. Neiman Health Policy Institute study found that Medicaid patients residing in states with higher Medicaid reimbursement were more likely to receive medical imaging. However, the number of imaging exams for Medicaid patients who underwent imaging did not vary based on reimbursement differences. This Journal of the American College of Radiology study was based on nearly 49 million Medicaid and Children’s Health Insurance Program (CHIP) beneficiaries 0-64 years of age in 2019.
As a state-run program, Medicaid reimbursement varies state-to-state. Rather than a simple comparison of Medicaid reimbursement across states, this study accounted for differences in the state prices using the Medicaid-to-Medicare reimbursement ratio (MMRR). This more refined measure considers the relative differences in Medicare reimbursement across states, which is adjusted for differences in the costs of providing care.
“The median MMRR ranged from a low of 0.76 for nuclear medicine to a high of 0.87 for CT, meaning that the median Medicaid payment providers receive for imaging ranges from 76% to 87% of what Medicare pays,” said Eric Christensen, PhD, Research Director at the Neiman Health Policy Institute. “Across the states there was substantial variation on Medicaid reimbursement compared to Medicare. For example, the median MMRR for X-ray was 0.82, but the bottom 25% of states had a ratio of 0.74 or less. The top 25%, however, had reimbursement close to (0.97) or above Medicare reimbursement. Hence, the differences in Medicaid reimbursement across states are not trivial.”
“Given these differences, we sought to investigate the association between Medicaid reimbursement levels and the utilization of medical imaging by Medicaid beneficiaries,” said Elizabeth Rula, PhD, Executive Director at the Neiman Health Policy Institute. “While utilization is not a direct measure of access, it is reasonable proxy. Providers paid significantly less for providing services to Medicaid patients versus other insured patients, may elect not accept Medicaid insurance. Our finding that states with lower reimbursement systematically have less Medicaid imaging utilization than higher-reimbursement states strongly suggests that reimbursement influences access to care.”
The percentage of patients who receive imaging was lower by approximately 25-28% for CT, MR and ultrasound at the 25th percentile versus 75th percentile of reimbursement, measured by MMRR. The largest difference was for X-ray, with utilization 38% higher at the 75th percentile of reimbursement compared to the 25th. “While our findings are not a direct measure of access to care, it is clear that Medicaid reimbursement is strongly correlated with utilization. The observed disparities show that having Medicaid coverage is not synonymous with equal access to care,” explained Dr. Christensen.
“The implication of our study is that increasing state Medicaid reimbursement is a logical option for improving access to care,” said Dr. Rula. “As a safety net program, Medicaid serves low-income Americans and a disproportionate percentage of beneficiaries who are Black or Hispanic. Eliminating Medicaid reimbursement gaps may reduce the health care and outcome disparities experienced by these underserved groups.”
To arrange an interview with a spokesperson, contact Nichole Gonzalez at ngonzalez@neimanhpi.org.
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About the Harvey L. Neiman Health Policy Institute
The Harvey L. Neiman Health Policy Institute is one of the nation’s leading medical imaging socioeconomic research organizations. The Neiman Institute studies the role and value of radiology and radiologists in evolving health care delivery and payment systems and the impact of medical imaging on the cost, quality, safety and efficiency of health care. Visit us at www.neimanhpi.org and follow us on Twitter, LinkedIn and Facebook.