Since the onslaught of the Medicaid audits on NC health care providers who accept Medicaid, I have been curious as to how many providers have determined that they no longer wanted to accept Medicaid.  Most of my clients have mentioned the fact that after their current issue (whatever that issue is), they were not going to deal with Medicaid anymore.  They are sick of the erroneous audits, the difficulty in dealing with the MCOs, the pile of paperwork they have to provide to state agencies over and over due to post or prepayment review. They are done with Medicaid.

Why should we care whether these providers continue to accept Medicaid?

Let’s not lose sight of the Medicaid recipients.  All these MCOs, RACs and other state agencies are so hell-bent on saving/recouping money, that Medicaid recipients’ mental health care has been lost.  1.5 million North Carolinians rely on Medicaid for their insurance.  Yet, less than 60% of physicians/providers accept Medicaid.  Even less accept Medicaid when you get into specialized services (approximately 30% dentists in NC accept Medicaid).  We need the providers who are willing to accept Medicaid.  Medicaid recipients need providers who are willing to accept Medicaid.

This is not the first time providers have been squeezed out of the Medicaid system.  Remember back in January 2011, approximately 1800 mental health providers were squeezed out of the system with the implementation of CABHA.  All the Medicaid recipients that were seen by providers who were squeezed out, were forced to transfer to other providers.  Again, no apparent thought to the care of the Medicaid recipients.

Now, in 2012 and 2013 and beyond, more mental health care providers are being squeezed out due to Medicaid audits, prepayment reviews, post-payment reviews, and suspensions of Medicaid reimbursements (all of which are grossly incorrectly administered).

So what happens to the 1.5 million Medicaid recipients?  Somehow the Medicaid recipients’ needs are being lost.  MCOs are terminating good provider contracts; RACs are auditing good providers out of business.  The Medicaid recipients are not receiving services.

Until now, I have seen no data on the number of providers that have recently decided to no longer accept Medicaid.

Insurance Participation Changes of MPA members from 2011/2012 to 2013

	2011 & 2012	2013	Change
Number of Members	180	176	-4
None (take no insurance)	34	54	20
Aetna	56	60	4
BC/BS	87	90	3
BC/BS State	58	63	5
BC/BS Fed	50	60	10
CBHA	42	53	11
Cigna	29	30	1
Medcost	36	43	7
Medicare	34	35	1
Medicaid	56	25	-31
Magellan	29	30	1
NC HealthChoice	22	17	-5
TriCare	17	24	7
United Behavioral Health	29	29	0
Value Options	24	27	3
Wellpath	12	14	2
Medicaid Changes
No longer accept Medicaid		-27
Moved – did not renew MPA Membership		-5
Did not renew MPA Membership in 2013		-1
New – members who accept Medicaid		+2
MPA 3013 Non-renewers	15
Moved	8
Declined	3
No response	4
Deceased	1
New Members 2013	13

Makes you wonder where the Medicaid recipients are now that their providers no longer accept Medicaid.  I guess the Medicaid recipients’ needs are still lost.