By the Numbers: Medicaid Patients’ Access to Care

In fall of 2023, the Washington State Medical Association partnered with Elway Research on a survey of Medicaid/AppleHealth enrollees in Washington state. We conducted a sample survey of the state’s total enrollment to provide a picture of the experience of Washington state patients.

Primary Care

A high percentage of Medicaid enrollees report having a physician for a primary care provider.

  • 8 of 10 respondents (81%) have a regular primary care provider (PCP).
  • 62% reported that their PCP is a physician.

Denial of Care

Access to primary care doesn’t tell the whole story: More than half (53%) had experienced denial of care or difficulty scheduling an appointment since they had been on Medicaid. Even patients who were referred by their doctors were sometimes denied care.

  • Nearly 4 in 10 (37%) had been denied an appointment.
  • 4 in 10 (39%) had trouble getting an appointment for specialty follow-up treatment that had been referred by their doctor.
  • 1 in 4 (24%) had trouble getting an appointment for medical treatment.

Having a doctor as a primary care provider helps get access to other care. Fewer than half (47%) of those with a physician PCP experienced difficulty in getting appointments and treatments, compared to 60% of people without a primary care provider, and 65% of those with a provider who wasn’t a physician.

Consequences

When people cannot access physicians or advance care practitioners because of their insurance, their suffering is likely to increase and their conditions can worsen. 8 in 10 (78%) of people denied care named at least one consequence, including:

  • Increased illness or discomfort (52%)
  • Increased pain (46%)
  • Decreased quality of life (45%)
  • Delayed diagnosis (32%)
  • Decreased ability to work (31%)

Alternative Actions Taken

There are not great options for care if you can’t get an appointment.

  • 2 in 10 (17%) said they would simply wait or go without care.
  • 8 in 10 (83%) would take some other action, including 49% going to an urgent care facility and 40% going to an emergency department.