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A New England Journal of Medicine article¹ recently attempted to estimate the impact of the expected increase in Medicaid enrollment due to the Patient Protection and Affordable Care Act (ACA) on access to primary care. The authors calculated the size of each state’s anticipated Medicaid expansion (in 2014) and compared it to the state’s primary care capacity. Those states with the highest “access-challenge index” are expected to face the greatest challenges in access to care immediately upon implementing the expansion. The eight states expected to experience the greatest difficulties are: Arkansas, Georgia, Kentucky, Louisiana, Nevada, North Carolina, Oklahoma, and Texas.

The authors note that while statewide data can provide an overall picture of where the access challenges are expected to be most severe, local areas and specific populations (such as special needs populations) could also face unique challenges. Access problems could be higher in rural or urban areas. Access challenges also may be heightened if physicians refuse to accept Medicaid patients.

Federal funding will be available to help address the primary care shortage in the form of increased investments in federally qualified health centers, the National Health Service Corps, as well as increasing the Medicaid reimbursement rate for primary care to match Medicare’s rate. Even so, a coordinated local-state-federal strategy will be needed. The chart below - “Access-Challenge Index for States, According to Rank”- is a helpful resource for states to begin to assess access barriers and consider where they will be most severe. 

¹Ku, Leighton, et al., “The States’ Next Challenge—Securing Primary Care to Expanded Medicaid Populations,” The New England Journal of Medicine 364;6, February 10, 2011.