Medicaid Patients Face Limited Access to Care for Ankle Sprains in Unexpanded States

Abstract

Purpose: Our goal was to determine whether state Medicaid expansion and patient insurance statuses affected access to care for ankle sprain patients.

Methods: Four pairs of Medicaid expanded (Kentucky, Louisiana, Iowa, and Arizona) and unexpanded (North Carolina, Alabama, Wisconsin, and Texas) states were chosen. Twelve practices from each state (N = 96) were randomly selected from the American Orthopaedic Foot and Ankle Society (AOFAS) directory and called twice to request an appointment for a fictitious 16-year-old with a first-time ankle sprain using either Medicaid insurance or Blue Cross Blue Shield (BCBS) private insurance.

Results: An appointment was obtained at 65.6% clinics when calling with BCBS and at 45.8% with Medicaid (P =.006). There was a significant difference in successful scheduling based on insurance status in Medicaid unexpanded states (P = .007). In all states except Iowa, there were more appointments scheduled using BCBS than with Medicaid. The 3 main reasons for appointment denial were inability to provide an insurance identification number (47.1%), insurance status (23.5%), and whether the patient was referred (17.6%). The waiting period for an appointment did not differ by Medicaid expansion or insurance statuses.

Conclusion: For patients with first-time ankle sprains, access to care is more difficult using Medicaid insurance rather than private insurance, especially in Medicaid unexpanded states.

Level of evidence: Level II prospective cohort study.

Keywords: Medicaid expansion; affordable care act; ankle sprain; pediatric.