One of the most notable benefits of the Affordable Care Act is its expansion of access to health coverage for people and families with low incomes: by 2014, the Act will provide for the extension of Medicaid coverage to all individuals with income up to 133 percent of the federal poverty level (FPL), should states opt to do so. Such an expansion of coverage will dramatically improve the lives of those with low incomes: a study has found that those with access to Medicaid coverage report better health, lower out-of-pocket medical expenditures and less medical debt.

This expansion of health coverage to the previously uninsured is a laudable achievement in its own right. But there must be a sufficient supply of primary care physicians and specialists available to deliver needed care. Safety Net Health Plans
(SNHPs) have built strong relationships and trust with community providers in a way that facilitates improved access to care for populations served by Medicaid, CHIP and Medicare. Indeed, many SNHPs were established by community health centers, public hospitals, and children’s hospitals so that these providers could secure their participation in the Medicaid program. But the adequacy of provider networks in Medicaid challenges states and health plans around the country, and as Medicaid expands to cover approximately millions of new enrollees in 2014, these challenges will be compounded, requiring commitment and creativity on the part of Medicaid plans and providers alike.

SNHPs employ several innovative approaches to broaden their provider networks; many are profiled in this paper. However, these approaches alone are not enough. Medicaid health plans must be assured that the rates paid to plans are appropriate and reflect the growth in services and population to be served.

View the full article »