Strengthening Medicaid

Everyone deserves access to quality health care. To ensure low-income patients enrolled in Medicaid receive needed care, the AMA works diligently at the state and federal levels to improve Medicaid programs, expand coverage options and make it easier for physicians to see Medicaid patients. 

Obtaining health insurance does not necessarily ensure better access to health care. Too often Medicaid patients face barriers to care, resulting in more frequent emergency department visits, delayed treatment of chronic conditions and poorer health outcomes.

Research demonstrates that low Medicaid reimbursement rates significantly affect a physician’s ability to accept new Medicaid patients. Physicians have a strong sense of responsibility to provide care for Medicaid patients, but cannot remain economically viable if they lose money on the care they provide. Without enough participating physicians, patients may have coverage but not real access to care.

To expand access to care, the AMA works with state advocates to fully fund the Medicaid program and increase physician participation with policies to streamline enrollment, ensure fair audit procedures and improve managed care programs.

To date, 38 states and the District of Columbia have expanded Medicaid coverage under the Affordable Care Act (ACA) to individuals with incomes up to 133% of the federal poverty level. Since this change, states have enrolled over 15 million people into Medicaid expansion programs. 74.6 million individuals are enrolled in Medicaid and CHIP nationwide.

The AMA works with advocates and policymakers at all levels of government to identify realistic coverage options for the uninsured and supports expansion plans that best meet the needs and priorities of states and low-income patients.

In many states, policymakers are testing new ways to serve the Medicaid population. Reform efforts must ensure that Medicaid is a viable and effective program to provide health insurance coverage to low-income individuals, seniors and the disabled. Changes in the financing of Medicaid should not undermine the overall coverage gains that have occurred under the ACA, particularly for individuals with the lowest income. 

• Issue brief: Medicaid access rule (PDF)
• Issue brief: Medicaid Managed Care final rule (PDF)

• Model bill: Streamlined Medicaid enrollment process for ordering and referring physicians (PDF)
• Model bill: Prohibiting mandatory physician participation in health programs (PDF, members only)
• Model bill: Medicaid coverage of the National Diabetes Prevention Program (PDF)

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• Medicaid expansion decisions by state (PDF)
• Research summary: Medicaid physician reimbursement (PDF)
• State advocacy roadmap: Medicaid access to care (PDF)
• Research summary: Benefits of Medicaid expansion (PDF)
• 2016 Letter to CMS concerning Medicaid access (PDF)
• 2019 Letter to CMS concerning Medicaid access (PDF)
• 2015 Letter to CMS concerning Medicaid managed care (PDF)
• 2019 Letter to CMS concerning Medicaid managed care (PDF)
• View AMA policies related to Medicaid in PolicyFinder
• Council on Medical Service Medicaid reports

For state advocacy issues, please contact Annalia Michelman, senior legislative attorney, [email protected].

For federal advocacy issues, please contact Debra Cohn, senior Washington counsel, [email protected].