Medicaid in D.P.C

(cjs56) #1

Generally speaking, are there are more lower income or middle income patients available for a D.P.C. practice in states that did NOT accept any funds for Medicaid expansion? That is, if there is no Medicaid expansion in a certain state, then perhaps there would be more patients available for a D.P.C. practice at an affordable price since those patients do not have Medicaid.
On the other hand, the states that did accept Medicaid expansion…California, New York, etc. then there are much more patients on Medicaid and thus probably less available to a D.P.C. practice.
There are 50 million people living in California. Further, 11 million are on Medicaid.
If a physician really wanted to help poor patients, it would seem that that it would be more financially possible in a state that did not accept Medicaid funding. No Medicaid expansion/funding almost forces the patients to pay themselves at an affordable D.P.C. rate (if they can afford it).
I wonder how many patients that would qualify for Medicaid in other states are members of the practices of D.P.C. physicians and are paying affordable D.P.C. rates in states that did NOT accept Medicaid funding?
Or, can they not afford any D.P.C. rate at all if they do not have Medicaid?

States with the most UNINSURED patients
(Dr Brian Pierce) #2

Hard to say. Without carefully measured data, you’re just going to get a bunch of anecdotes heavily filtered by unconscious political bias.

In Maine, I have a lot of patents who don’t qualify for Medicaid but I also have plenty of patients who do have Medicaid and still sign up with me.

(cjs56) #3

Maine medicaid can afford to sign up with a D.P.C. physician. The California Medicaid can’t afford to sign up with a D.P.C.

I have another question coming up.

(Robin Dickinson) #4

I’d say it’s probably more complicated than that. Colorado expanded Medicaid and we also have the most DPC and just anecdotally it seems most of us care for a lot of working class folks.

To qualify for Medicaid, you have to be under 133% of the FPL here (under about $1100 a month as a single, under $2500 a month as a family of four). Rent in my very modest area (per capital income of $28K) is currently about $1200 for a studio apartment. I’ve patients paying $800 for a basement bedroom and access to a bathroom. I’ve a number of patients who earn too much for Medicaid but are still quite definitely lower or middle income. $2500 a month is what, $30K a year? It takes about 250% of the FPL to be able to afford the basics in most areas and 350-400% FPL to feel really stable imo.

If you’re finding there are a lot of people in the 250-400% FPL not interested in DPC, it’s more likely because of something other than Medicaid.

(cjs56) #5

Thanks. That helped me. In addition to personal/family income, F.P.L. (Federal Poverty Level) percentage as a requirement for Medicaid eligibility is probably different in each state.
So, the tougher the financial income criteria to be eligible for Medicaid, and the less that state took of Obamacare money, then, theoretically, there should be more uninsured patients available for a D.P.C. practice.
What say you?

(Orsolya Polgar) #6

Great topic! Does anyone know if Maryland has a Medicaid “ordering and referring only provider” option? Thanks.

(cjs56) #7


  1. do you find that many D.P.C. patients go back and forth from D.P.C. membership to Medicaid?
  2. In other words, simply/more directly asked…many or few?
  3. I assume you find that by “opting in” for Medicaid, this helps you retain a D.P.C. patient that may go on Medicaid for a short time period and then bounce back to D.P.C. retainer fee when financially able? Have you found this to be the case?
  4. have you found that when D.P.C. patients have to go on Medicaid, that at times, they remain stuck on Medicaid and are not able to go back to former D.P.C. status? That would mean that the D.P.C. physician would then see a growing Medicaid patient population.
  5. Would Medicaid allow a D.P.C. physician to only accept Medicaid patients that were former D.P.C. patients? Or, would Medicaid require a physician to take all Medicaid “comers”…that is, a physician, if enrolled in Medicaid, must be open and accept all Medicaid patients…not just former D.P.C. patients? Or, no such rule…that is…can take as many Medicaid or as few as the physician wants?
  6. Thank you.
  7. Stephen

of Robin Dickinson

(Robin Dickinson) #8

In my state people used to go on and off Medicaid month to month and then I might have a handful every month. Now, there is a place on the Medicaid application to check a box and enter your annual income, and that has significantly reduced flux. Before, someone might lose Medicaid on a 3-paycheck-month (if they are paid every 2 weeks) but otherwise qualify for it.

Yes. I see mostly young families so oftentimes they will be on Medicaid if Mom’s off work due to pregnancy complications or while the family business is growing or if a parent loses a job or something. I have some who are chronically on Medicaid but I’m pretty close to my patients and I don’t mind.

Mine seems to stay really stable. Since I only accept new patients for DPC, I seem to have even numbers with their situation improving and their situation worsening. So my total numbers are stable but my percentage of Medicaid is dropping (since I’m still accepting new DPC). I truly believe that good primary care helps people improve their situation and get off Medicaid because getting treatment for what ails (including physical and mental health problems) allows people to move on with their lives

At least in my state, I can opt to be “open” or “closed”. I keep my practice “closed” but I can still add as many new patients as I want, I just don’t get the $2 PMPM primary care medical home fee on those patients. I can reopen once in awhile, add all those patients that have gotten on Medicaid in between times, and then close again…but I haven’t done that because it’s not worth it to me. A lot of this depends on having someone sympathetic. I go way back with a woman who is an administrator with my regional care collaborative for Medicaid so if I’m having a problem, I just email her. Unfair, but it helps.

(Elizabeth Hart) #9

I would agree anecdotally that this theory should be right. I live in Oklahoma and we did not expand medicaid and have currently only bcbs left in the exchange so premiums and dedectibles are astronomical. There doesn’t seem to be much info readily available…yet. Something we do have in Oklahoma is fmma which I think is really on the ground floor of helping open up options in healthcare in Oklahoma, and nationally. The first surgery center to post their all-inclusive bundled prices online…basically the teachers union tpa agreed to include said surgery center in their network. …and the list goes on.
I think Oklahoma has great dpc potential and several docs were quickly successful/ready to expand and there are new ones emerging all the time.