The Social Security Act directly addresses access and quality in Medicaid with its requirement that Medicaid payment levels are “consistent with efficiency, economy, and quality of care,” and “sufficient to enlist enough providers so that care and services are available under the plan at least to the extent that such care and services are available to the general population in the geographic area.”
MACPAC has developed a framework for examining access to care for Medicaid and CHIP enrollees that builds on many years of research in defining and measuring access to care, and is tailored to reflect program policies, special characteristics of enrollees, and factors these populations may face when seeking appropriate care. When evaluating access, it is important to consider:
- People: Medicaid and CHIP enrollees differ from the general population in terms of their demographic characteristics, health needs, and how they qualify for coverage.
- Availability: The availability of providers reflects both the characteristics of local health care markets and state policies and provider responses to those policies (for example, provider payment rates, provider participation rates, willingness to accept Medicaid, and scope of practice).
- Use of health care services: Use of services reflects both whether services are covered benefits, affordability to the enrollee, the enrollee’s ability to navigate the health care system, and enrollees’ satisfaction with their health care, and whether the care is considered to be necessary or appropriate.
MACPAC’s work on access has focused on all three components of this access framework with analyses on enrollee characteristics, enrollees’ use of services, and the relationship between provider payment and use of services.
Read more about MACPAC’s access framework:
Examining Access to Care in Medicaid and CHIP (March 2011)
