Finding a doctor can be challenging if you're on Medicaid, but the state and federal government are trying to change that.
Starting next month, Michigan will be increasing the amount of money it pays doctors who treat Medicaid patients but only for a very limited range of primary care services. A bigger change comes in 2013 and 2014, under the Affordable Care Act.
For two years, doctors will be reimbursed for Medicaid at the same rate as Medicare. Historically, Medicaid payments have been low when compared with private insurance and Medicare, which covers seniors and the disabled.
"The number of patients in Michigan who are covered by Medicaid has gone up, it's at the highest level it's ever been yet simultaneously we're having a hard time finding access for these patients to care," primary care physician, Dr. Peter Graham, with Sparrow Hospital said.
While many physicians want to treat the low income, they say they also need to make a living. Under Medicaid, patients usually pay nothing for covered medical expenses.
"It costs a lot of money to open a doctors office, it costs a lot of money to have decent staff, electronic medical records, all of the things that are necessary to provide quality care," Dr. Barry Saltman, with Lansing and Mason's Care Free Clinic said. "When you're seeing patients for $26, $27 and $28 a visit and are expecte to spend 10, 15, 20 minutes with that patient it doesn't take long to figure out you can't make ends meet.
The goverment reimburses doctors for some of the expense, but with many physicians coming out of medical school with loans nearing $200,000 Saltman says it's not enough.
"It's as if they bought a house they're never going to live in," Graham added. "So layer that on top of the cost of maintaining your practice for a lot of us especially in primary care, family medicine, pediatrics, general internal medicine the margins are very, very thin and they've gotten thinner as time goes by."
Nationally, less than 65 percent of primary care physicians accept new patients with Medicaid.
Hoping to change that, the Affordable Care Act will increase reimbursements. In 2013-2014 Medicaid payments for primary care will be the same as Medicare.
"In the short run that improves access because for a lot of the physicians one of the biggest barriers to taking care of medicaid patients was finance," Graham said.
But he worries that benefit will be short lived. After two years the payments diminish.
"So doctors particularly those just getting started or those in the middle of their careers are goign to take a look and say wait a minute, for two years I'll be okay but what do I do with these patients I see now when I can't make a living with them again?" Saltman said.
Saltman says doctors are also wary of taking on Medicaid patients, because they worry they can not address all of their needs. Primary care physicians find it very difficult to get their patients into sub-specialists, like neurologists or cardiologists.
"A lot of subspecialists will absolutely flat out refuse Medicaid," Graham explained.
Still, he says doctors and hospitals recognize health care needs to change.
"It's too expensive," Graham said. "20 percent of GDP, it's not going to stay that way forever, it can't."