The average application processing time is the  average number of calendar days between the receipt of a new  application and the final determination of eligibility. 1.) 2.) Because of data limitations, we were unable to assess the extent to which  the number of applications states processed kept pace with the number of  new applications received each month from January 2008 through  December 2011. Most states provided incomplete or inconsistent data on  new applications received and processed. States Made Numerous Changes to Provider Payments and Beneficiary Services

States reported changes—both increases and decreases—to provider  payment rates, provider taxes, and beneficiary services since 2008. The Number of States Reducing Providers’ Payments or Implementing Supplemental Payments Grew

The number of states that reported making at least one payment rate  reduction grew from 13 in 2008 to 34 in 2011, while the number of states  increasing at least one provider payment rate fell over the same period. Overall, more states reported increasing provider payment rates in 2011  than reducing them. 4.) From 2008 through 2011, states reported making more changes to  coverage for dental, primary, and specialty care services and prescription  drug benefits than for other services. Over Two-Thirds of States Reported Challenges Ensuring Sufficient Providers, Including Dental and Specialty Providers

Of the 55 states responding to our survey, 38 states reported  experiencing challenges to ensuring enough participating providers for  Medicaid beneficiaries. Full-Year Medicaid Beneficiaries Reported Similar Difficulty Obtaining Needed Medical Care as Privately Insured Individuals

Beneficiaries covered by Medicaid for a full year reported low rates of  difficulty obtaining necessary medical care and prescription medicine,  similar to those with private insurance for a full year.2008 and 2009, approximately 3.7 percent of Medicaid beneficiaries  enrolled for a full year and 3 percent of individuals enrolled in private  insurance for a full year reported difficulties obtaining needed medical  care; the difference between these two groups was not statistically  significant. Full-year Medicaid   In calendar years  beneficiaries did however, report experiencing greater difficulty obtaining  necessary dental care than those with full-year private insurance. Medicaid beneficiaries were more likely than individuals with private  insurance to report factors such as lack of transportation and long wait  time as reasons for delaying medical care. Individuals who were  uninsured were the most likely to cite cost as a reason for delaying care. We provided a draft of this report to HHS for its review and comment. HHS provided technical comments, which we incorporated as  appropriate. Development and Analysis of GAO Survey of States

To examine states’ experiences processing Medicaid applications, states  were asked to report their current average processing time for new  regular Medicaid applications—those not based on disability—and how  those times changed since 2008.about the factors states attributed to any reported changes in the average  processing time for Medicaid applications. Analysis of Other Federal Health Care Consumer Survey Data

To examine the extent to which Medicaid beneficiaries reported difficulties  obtaining care, we analyzed data from the Medical Expenditure Panel  Survey (MEPS) and the National Health Interview Survey (NHIS). In addition to  determining the extent to which full-year Medicaid beneficiaries had  difficulty accessing care, we also compared Medicaid beneficiaries’  reported experiences to the experience of respondents with private  insurance and respondents who were uninsured, in order to provide  context.Medicaid for a full year reported greater difficulty accessing medical care  than children in Medicaid or full-year Medicaid beneficiaries 65 and older.
Why GAO Did This Study

Medicaid enrollment has grown significantly in recent years due to the economic downturn. This growth is expected to continue as the Patient Protection and Affordable Care Act potentially extends Medicaid eligibility in 2014 to millions of uninsured individuals. To better understand whether states are providing adequate access to medical care for beneficiaries, this report examines (1) states' experiences processing Medicaid applications, (2) states' changes to beneficiary services and provider payment rates, (3) the challenges states report to ensure sufficient provider participation, and (4) the extent to which Medicaid beneficiaries reported difficulties obtaining medical care. To examine the first three objectives, GAO administered a nationwide web-based survey to Medicaid officials on states' experiences from 2008 through 2011 and obtained a response rate of 98 percent. To examine the last objective, GAO analyzed data from the 2008 and 2009 Medical Expenditure Panel Survey, the most current available at the time of our analysis, to assess Medicaid beneficiaries' reported difficulties obtaining care, and the 2009 National Health Interview Survey to assess their reasons for delaying care. To provide context, we compared their experiences to those of individuals with private insurance or who were uninsured.

What GAO Found

From 2008 to 2011, more than half of states reported maintaining or decreasing their average Medicaid application processing times--the average number of calendar days between the receipt of a new application and the final determination of eligibility. The average processing times reported by 39 states ranged from 11 to 45 calendar days. For the same time period, however, GAO was unable to assess whether states processed applications at a rate that kept pace with the number of new applications received each month, because most states provided incomplete or inconsistent data.
States reported making numerous changes to provider payments, provider taxes, and beneficiary services since 2008. While more states reported provider-rate and supplemental payment increases each year from 2008 through 2011, the number reporting payment reductions and increased provider taxes also grew. More states reported increasing services than limiting them.
Over two-thirds of states reported challenges to ensuring enough Medicaid providers to serve beneficiaries--including dental and specialty care providers. States cited Medicaid payment rates and a general shortage of providers as adding to the challenge. To attract new providers, over half the states reported simplifying administrative requirements or increasing payment rates.
In calendar years 2008 and 2009, less than 4 percent of beneficiaries who had Medicaid coverage for a full year reported difficulty obtaining medical care, which was similar to individuals with full-year private insurance; however, more Medicaid beneficiaries reported difficulty obtaining dental care than those with private insurance. Beneficiaries with less than a full year of Medicaid coverage were almost twice as likely to report difficulties obtaining medical care as those with full-year coverage. Medicaid beneficiaries reported delaying care for reasons such as long wait times and lack of transportation.
The Department of Health and Human Services reviewed a draft of this report and provided technical comments, which GAO incorporated as appropriate.