1 - Medicaid Expansion: A Mixed Method Story from the Provider Perspective

Abstract Information:

Background: In 2020, Missouri voters passed a constitutional amendment expanding Medicaid coverage to an estimated 225,000 to 275,000 people, with many new enrollees likely to come from rural and other health care workforce shortage areas. This study focuses on health care providers due to the key role they play in the successful implementation of Medicaid expansion.

Methods: This study uses a mixed-methods approach. Phase 1 involved conducting structured key informant interviews with rural providers who saw at least 10 Medicaid patients during the previous year (N=15). Phase 2 is a survey with health care providers who currently treat Medicaid patients or who would be willing to do so in the future.

Results: Qualitative results showed that participants had generally favorable views about Medicaid expansion and increased access to healthcare, though they were concerned about capacity within their practice and the health care workforce. Participants also reported challenges working with the Medicaid program, challenges treating Medicaid patients, and having received little formal training on Medicaid or expansion. Quantitative results which expand on these themes will also be presented.

Conclusion: During Phase 1 of this study, we used health care providers’ stories to develop our survey instrument and evaluate Medicaid expansion from the provider perspective. Key themes suggest that heath care providers may experience barriers to caring for new Medicaid enrollees. Phase 2 will provide quantitative evidence on the prevalence of these issues for providers.

Relevance Statement: This study expands on a small body of emerging Medicaid research which focuses on health care providers rather than enrollees. We use a mixed-methods approach to gather both qualitative and quantitative data to fully tell the story of Medicaid expansion from the provider perspective. Our research design will also allow us to combine survey data with administrative data, as we will be able to link the majority of survey responses to providers listed in the MO HealthNet Medicaid Provider File. Audience members will gain insight in evaluating Medicaid expansion from the provider perspective using mixed methods in an urban and rural setting.