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Improving Access to Specialty Care for Medicaid Patients: Policy Issues and Options

Commonwealth Fund Report
June 2013
Laurie E. Felland, Amanda E. Lechner, Anna Sommers

In some states and communities, Medicaid programs, health plans, providers, and others are collaborating to improve timely access to medical and surgical specialty services for Medicaid enrollees. This report examines six specialty care models—in Connecticut, Illinois, Minnesota, New Mexico, Oregon, and Tennessee—that support innovative ways of delivering specialty care and ensure specialty referrals for Medicaid patients are appropriate and efficient. Strategies include finding ways for specialty providers to deliver care at primary care facilities, expanding the role of primary care providers to deliver specialty care, and employing staff to focus on communication and coordination across providers. Although resources remain limited, participating organizations report better access to specialty care for Medicaid patients and early signs of improvements in quality and costs of care. However, sustaining, expanding, and replicating these models may require changes in Medicaid payment methods that recognize new types of interactions with patients beyond face-to-face visits.

Access to this article is available at The Commonwealth Fund website.




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The Center for Studying Health System Change Ceased operation on Dec. 31, 2013.