Study: Few primary care providers participate in both Medicaid and Marketplace plans

Fewer than three in 10 primary care physicians participating in Medicaid also participated in an average marketplace network, raising concerns about continuity of care for beneficiaries disenrolled from Medicaid (Source: “Few Physicians Participate in Both Medicaid and Marketplace Plans,” Health Payer Intelligence, March 7).
 
States resumed Medicaid eligibility determinations in April 2023 before the COVID-19 public health emergency ended. As of October 2023, Ohio’s Medicaid enrollment had decreased by 259,670, according to Ohio Department of Medicaid data included in a December 2023 HPIO publication titled “Ohio Medicaid Basics Update: Unwinding of the Medicaid Continuous Enrollment Provision.”
 
Beneficiaries who lose Medicaid coverage may be eligible for premium subsidies on the Affordable Care Act (ACA) marketplace. However, care continuity may not be so simple for these individuals if there is not a lot of overlap between physicians accepting Medicaid and marketplace plans.
 
The study published in JAMA Internal Medicine used 2020 physician directory data and rating area information from CMS to assess Medicaid-marketplace overlap among primary care physicians. Researchers identified primary care physicians participating in Medicaid and marketplace plans offered in 15 states with statewide Medicaid networks.