title: Primary care appointment availability for new Medicaid patients increased after Medicaid expansion in Michigan.
abstract: The Affordable Care Act expands health insurance coverage to millions of Americans, but the availability of health care services for the newly insured population remains uncertain. We conducted a simulated patient (or "secret shopper") study to assess primary care appointment availability and wait times for new patients with Medicaid or private insurance before and after implementation of Michigan's Medicaid expansion in 2014. The expansion, which was made possible through a section 1115 waiver, has a unique requirement that new beneficiaries must be seen by a primary care provider within 60-90 days of enrollment. During a period of rapid coverage expansion in Michigan, we found that appointment availability increased 6 percentage points for new Medicaid patients and decreased 2 percentage points for new privately insured patients, compared to availability before the expansion. Wait times remained stable, at 1-2 weeks for both groups. Further research is needed to determine whether access to primary care for newly insured patients will endure over time.
authors.affiliation: Renuka Tipirneni (rtipirne@med.umich.edu) is a Robert Wood Johnson Foundation Clinical Scholar and clinical lecturer in the Department of Internal Medicine at the Medical School and a member of the Institute for Healthcare Policy and Innovation, both at the University of Michigan, in Ann Arbor.
authors.forename: Renuka
authors.initials: R
authors.lastname: Tipirneni
authors.affiliation: Karin V. Rhodes is an associate professor of emergency medicine and director of the Center for Emergency Care Policy and Research at the Perelman School of Medicine, University of Pennsylvania, in Philadelphia.
authors.forename: Karin V
authors.initials: KV
authors.lastname: Rhodes
authors.affiliation: Rodney A. Hayward is a professor of internal medicine and public health and a member of the Institute for Healthcare Policy and Innovation at the University of Michigan and a senior research scientist at the Veterans Affairs Center for Clinical Management Research, both in Ann Arbor.
authors.forename: Rodney A
authors.initials: RA
authors.lastname: Hayward
authors.affiliation: Richard L. Lichtenstein is the S. J. Axelrod Collegiate Professor of Health Management and Policy at the School of Public Health and a member of the Institute for Healthcare Policy and Innovation, both at the University of Michigan.
authors.forename: Richard L
authors.initials: RL
authors.lastname: Lichtenstein
authors.affiliation: Elyse N. Reamer is a research assistant at the Robert Wood Johnson Foundation Clinical Scholars Program in the Medical School at the University of Michigan.
authors.forename: Elyse N
authors.initials: EN
authors.lastname: Reamer
authors.affiliation: Matthew M. Davis is a professor of pediatrics, internal medicine, and public policy and deputy director of the Institute for Healthcare Policy and Innovation at the University of Michigan.
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Davis
mesh_terms: D001071:Appointments and Schedules; D018166:Health Care Reform; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D019458:Insurance Coverage; D008484:Medicaid / Q000191:economics / Q000706:statistics & numerical data*; D008824:Michigan; D058991:Patient Protection and Affordable Care Act / Q000191:economics / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000191:economics / Q000706:statistics & numerical data*; D014481:United States
keywords: Access To Care; Health Reform; Insurance Coverage < Insurance; Medicaid, Primary Care