Wait Time Not Significantly Increased After Michigan Medicaid Expansion

Patients who signed up for Medicaid post-expansion had a better chance of getting an initial appointment.

A recent study found that Michigan’s Medicaid expansion did not crowd doctors’ offices with Medicaid patients and leave no room for patients with other insurance.

The study, published in The American Journal of Managed Care, found that 600,000 patients who signed up for the Healthy Michigan Plan had better odds of getting an appointment and similar wait times for a first appointment compared with pre-expansion rates.

The researchers also found that patients with private insurance had no decline in the amount of clinics that would take them as new patients. The wait time for a first appointment was not significantly increased either.

The Healthy Michigan Plan enrolled 90% of uninsured working-age adults within 1 year of expansion, according to the study.

"One year after Medicaid expansion in Michigan, primary care appointment availability for new Medicaid patients increased, even though enrollment in the program almost doubled," said lead author Renuka Tipirneni, MD, MS.

The researchers employed a “secret shopper” method, and called nearly 300 primary care clinics prior to expansion and 3 times within the first year post-expansion. Researchers pretended to be patients seeking an appointment with a new healthcare provider.

They discovered that 49% of clinics pre-expansion and 55% of clinics post-expansion offered an appointment to researchers who posed as patients insured through Medicaid. It was also found that 88% of clinics pre-expansion and 86% of clinics post-expansion offered an appointment to researchers who posed as patients with private insurance.

Wait times for the first available appointment for patients with all insurance was approximately 1 week prior to expansion. However, researchers found that the wait time increased by 3 days for patients with private insurance within the first 4 months of expansion.

"This unexpected increase in appointment access may be partially explained by the growing importance of non-physician providers, such as nurse practitioners and physician assistants," Dr Tipirneni said.

Approximately 8% of researchers posing as new Medicaid patients and 11% of researchers posing as patients with private insurance would have seen a nurse practitioner or physician’s assistant at their first appointment. These rates increased to 21% and 18%, respectively.

This study does not distinguish between privately insured patients that bought their plan through Affordable Care Act health exchanges or employer plans, and it did not distinguish patients who had traditional Medicaid coverage and Health Michigan Plan coverage.