Summary: A study found that higher Medicaid reimbursement rates are linked to increased medical imaging utilization, highlighting disparities in access to care and the need to address reimbursement gaps to improve equity for underserved populations.
Key Takeaways
- Higher Medicaid reimbursement rates are associated with increased imaging utilization, but the number of exams per patient does not vary with reimbursement levels.
- Substantial state-to-state variation in Medicaid-to-Medicare reimbursement ratios highlights disparities, with lower reimbursement linked to reduced access to imaging.
- Addressing Medicaid reimbursement gaps could improve access to care and reduce healthcare disparities, particularly for underserved populations such as low-income, Black, and Hispanic individuals.
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A study by the Harvey L. Neiman Health Policy Institute found that Medicaid patients in states with higher reimbursement rates were more likely to undergo medical imaging. However, among those who received imaging, the number of exams did not vary based on reimbursement levels. Published in the Journal of the American College of Radiology, the study analyzed data from nearly 49 million Medicaid and Children’s Health Insurance Program (CHIP) beneficiaries aged 0-64 in 2019.
Medicaid reimbursement varies across states, reflecting differences in the cost of care. To enable fair comparisons, researchers used the Medicaid-to-Medicare reimbursement ratio (MMRR), which adjusts for cost variations.
Low Medicaid Pay May Limit Providers
“The median MMRR ranged from 0.76 for nuclear medicine to 0.87 for CT,” says Eric Christensen, PhD, research director at the Neiman Health Policy Institute. “This means that Medicaid providers typically receive 76% to 87% of what Medicare pays for imaging. However, substantial variation exists. For example, the median MMRR for X-ray was 0.82, but the lowest quartile of states had ratios of 0.74 or less, while the highest quartile had ratios of 0.97 or more. These differences are not trivial.”
Elizabeth Rula, PhD, executive director at the Neiman Health Policy Institute, emphasized the connection between reimbursement and imaging utilization: “Providers paid significantly less for Medicaid patients may choose not to accept Medicaid, reducing access to care. States with lower reimbursement systematically show less imaging utilization among Medicaid beneficiaries, strongly suggesting that reimbursement levels influence access.”
Reimbursement Gaps
The study revealed a 25%-28% lower likelihood of CT, MRI, and ultrasound utilization in states at the 25th percentile of reimbursement compared to those at the 75th percentile. The disparity was even greater for X-ray, with utilization 38% higher in states with higher reimbursement. “While not a direct measure of access, the strong correlation between reimbursement and imaging utilization highlights that Medicaid coverage does not guarantee equal access to care,” Christensen says.
Rula concludes, “Increasing Medicaid reimbursement is a logical step to improve access to care, especially for underserved populations. Medicaid disproportionately serves low-income Americans, including Black and Hispanic individuals. Addressing reimbursement gaps could help reduce healthcare disparities and improve outcomes for these groups.”
