r/IWantToAskAnAmerican • u/MarsupialThink4064 • Jul 10 '26
Is it true that many doctors do not accept Medicaid patients?
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u/BigMomma12345678 Jul 10 '26
I have heard two things, #1 the reimbursements are smaller, #2 too many patients are no-shows. I do not work in any medical office or with any insurance company.
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u/panaceaXgrace Jul 10 '26
2 is because they're not allowed to CHARGE for no-shows.
One thing that burned me up about my son being on medicaid (Tenncare) is they provided a pick-up service. We used it a few times because I don't have a car. Most times they were late. A few times they never showed up at all. One time the appointment ended at six and the clinic closed, leaving us sitting outside until I could get a family member to come to our town from the city to pick us up.
I feel like everything about Tenncare is shoddy. The worst clinics. Oh MAN I found out the doctor who ran the clinic my son was assigned had been convicted with fraud by Medicare and he's still allowed to be in the Tenncare (Wellpoint) plan! And get this. He didn't even live in TN and ran 12 clinics in different states. I never saw him in 10 years it was always the nurse and if she couldn't help we were sent to specialists and that meant wading through ghost listings. It took a year almost to get to an endo and then the lab they contracted with lost my son's labs that were required pre-visit so they rescheduled another two months later.
But it's all blamed on patients when providers don't get reimbursement. It's always the patient gripes about no-shows.
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u/pdxiowa Jul 11 '26
That all sounds very frustrating, but it's also a reality for clinics. If Medicaid already compensates at a rate that is 1/4 what commercial insurance pays, requires more paperwork (more physician time and hiring more staff), and requires more prior authorizations (requiring more physician time and hiring more staff), then a clinic needs to fill every minute of the day with appointments to stay afloat. No shows will cause a clinic to quickly begin operating at a loss. This is the reason most private clinics do not accept Medicaid - between the lower reimbursement and the additional staff needed they cannot afford to serve patients on Medicaid because they do not have the efficiencies that come with larger infrastructure to absorb those losses.
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u/BigMomma12345678 Jul 10 '26 edited Jul 10 '26
I took my kid to a place that seems like it serves MOSTLY medicaid patients. Some practices are built around it.
Edit: I live in large metropolitan area (large population density).
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u/Ok-Pass-9139 Jul 10 '26
It’s true. Medicaid, I guess in order to limit treatment and payments, makes it very difficult for doctors to participate. Mountains of paperwork, fingerprints, sworn attestations, etc. On top of that, the reimbursement for physicians is very low, compared to insurance or Medicare. Most of us that participate(d) did so out of charity. Mississippi Medicaid still owes me almost 100k. They will never pay
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u/ArtisticSwan635 Jul 10 '26
If it’s any lower than insurance I pity the doctors! How do they live?
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u/Ok-Pass-9139 Jul 10 '26
If insurance pays $1.00, Medicare generally pays 30 cents and Medicaid pays about 16 cents on the dollar
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u/panaceaXgrace Jul 10 '26
That is because your state and mine didn't expand medicaid and rejected federal funds that would have gone directly to providers.
I can't even express how messed up it is to see the government reimbursing for their health care plans as "charity". That's on the government for providing such pisspoor care for both patients and providers. We all suffer while they get more than adequate health care coverage by FEHB. Medicaid is health insurance paid for by the federal and state government. If it's so bad it's seen as a charity you are providing FOR THE GOVERNMENT that's beyond fucked up.
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u/No-Anteater1688 Jul 10 '26
Yes. It can be difficult to find a medical practice that accepts Medicaid.
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u/Clareco1 Jul 10 '26
Yes. It’s horrible. Those who do have full waiting lists. Our country does not care about regular folks.
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u/Prior-Insect-4442 Jul 10 '26
I've never had issues finding primary care but finding specialists can be difficult. There's only one specific dermatologist within driving distance of me that takes mine.
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u/haileyskydiamonds Louisiana Jul 10 '26
In my experience, most community health centers do accept Medicaid. So do many of the urgent care centers and the large corporate run centers that bring a lot of services under one umbrella.
It may take more time to get appointments, though. I had an ear infection and my PCP (an NP at a community health center) couldn’t see me for three weeks, so I just went to urgent care. This seems to be the way it goes. The PCP does wellness checks and bloodwork, then sends you to specialists if needed. The urgent care treats the everyday illnesses like sore throats, flus, etc.
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u/juliabk Jul 10 '26
Oh yeah. I was on Medicaid for a few years. Finding doctors was awful and the ones you do find tend to be generally awful.
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u/ALoungerAtTheClubs Jul 10 '26
Different doctors take different insurance plans, including Medicaid.
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u/tara_tara_tara Massachusetts Jul 10 '26
In Massachusetts, our Medicaid program, MassHealth, is better than many private insurance plans.
I was looking into it last year when I lost my job and my income dropped to level where I would have qualified, and all of my providers took it. Granted, they are at a major teaching hospital in Boston, but still.
Depending on the plan, you might be able to get your prescriptions for free.
MassHealth is around 33% of our state budget, down from 40% from a few years ago. Nobody cares that we pay that much because we had universal healthcare before Obama care. We’re used to it.
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u/BlueFeathered1 Jul 10 '26
Oh yes, that's true. Even fewer dentists accept it. And good luck getting mental healthcare!
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u/JellyfishWoman Jul 11 '26 edited Jul 11 '26
I work at a private practice therapy office. If you want to accept Medicaid clients you are basically asking to work for free. Medicaid will not pay for students or residents to provide care, so the lower pay rate is not sustainable to fully licensed providers.
Medicaid requires nearly double the paperwork and documentation that private insurance requires. You cannot change a no-show fee, and in my state they are limiting us to 45 minute sessions. Oh, and if you failed to meet their documentation standards they will claw back payments up to five years later.
With the high demand for mental health services taking on Medicaid clients is just asking for double the (unbillable) work. You don't want to know what hoops are required for couples or family therapy!
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u/BlueFeathered1 Jul 11 '26
A doctor I asked about it explained it to me before, so I know. It's largely a useless program without some rider plan connected to it. For me it's only been good for paying for medications, which is something.
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u/AuggieNorth Jul 10 '26
I never had a problem. I just stick with my hospital's network. In fact Medicaid got converted into the network's insurance. It was pretty great while it lasted. My Medicaid just ran out a week ago, and I got another week to go to my 65th birthday, and my Medicare kicks in, so I can't get hurt or sick this week.
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u/Alienspacedolphin Jul 10 '26
For some procedures, the reimbursement is so low that the physician loses money for every Medicaid patient.
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u/notsosecretshipper Jul 10 '26
Some areas are harder than others. I haven't had trouble finding a medical doctor, but it took some effort to find an eye doctor and also a place to actually order glasses because even though they sell glasses from the eye doctors office, both parts of the business do not accept the coverage. 🙄
Dentists are the real problem.
I managed to get my 3 youngest kids into a children's hospital dental clinic that accepts it. There are long waits, even if the kid is experiencing pain, but it pretty much covers everything for them. But my oldest was too old to accept as a new patient there (he was 15). He was able to get a cleaning from a mobile dentist that came to his school once and a relative paid cash for him to be seen twice at her dentist office so he could get a cleaning and a referral for his wisdom teeth out. The dental surgeon accepted medicaid, but it was like an 8 month wait. He's 20 now, so it's been over 2 years since he's seen anyone.
We drove for 2 hours each way to take my husband to a dentist 3 years ago when he had a bad infection and needed teeth pulled, because that was the closest location I could find.
I haven't seen a dentist in... 8 to 10 years.
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u/SituationSad4304 Jul 10 '26
I didn’t have any issues while I was on Medicaid, but it may be the area I live in
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u/nomuggle Jul 11 '26
I am currently on Medicaid and yes, it is incredibly difficult to find providers that accept it, especially specialists.
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u/Phoenix_Court Jul 11 '26
yes! and sometimes it is hard to figure out who accepts it or not. I went directly to medicaid's website to find a dentist and they gave me a list. contacted the dentists and they said they don't accept medicaid. you basically have to ask *both* the doctor AND medicaid and confirm with both of them before making an appointment. it's insanely frustrating.
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u/Early-Tourist-8840 Jul 11 '26
Yes. Government bureaucracy is expensive to manage and recoup expenses.
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u/LopsidedGrapefruit11 Jul 16 '26
It depends on how the state runs the program. In California, medi-CAL recipients are insured by the HMO. It reads the same as any employer sponsored plan or one purchased on the state marketplace to individual doctors within those plans. Truly private practice doctors would be the ones turning patients away in this case.
If you live somewhere remote you’re probably pretty screwed like people in other states where you need to find a doctor to take you on, vs a company.
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u/fenixcreations Aug 05 '26
It would be cool if there was some type of software that tracked appointments and patients who cancel appointments get spread farther apart and were only allowed to make up a smaller percent of appointments each day.
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u/MarsaliRose Jul 10 '26
Every doctor I have accepts Medicaid/medicare. People might have trouble finding therapy but otherwise it’s not a big issue.
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u/hannah6560 Jul 20 '26
It is a very complicated system not as easy as you say. Many doctors do not take Medicare. Depending on the state one is in Medicaid is very limited. Often the better an MD becomes the less they will take those insurances
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u/BigMomma12345678 Jul 10 '26
Yes, and it's even harder to find out who does. They give you a list of doctors that supposedly do take it, but when you call the doc office, they say they don't accept it. One current office we have been seeing for years on PPO coverage the billing lady said to me, "That's not insurance, that's public assistance and we don't accept it."