Recent efforts on the part of U.S. Virgin Islands Governor Kenneth E. Mapp have resulted in the federal Medicaid program being made available to an additional 19,000 citizens in the Territory. However, reports continue to circulate about physicians denying medical services to Medicare and Medicaid patients.
An official complaint regarding this denial of care was made by Dr. Frank Odlum, Chair of the Board of Medical Examiners for the U.S. Virgin Islands, to Attorney General Claude Walker. Walker said he is “deeply troubled” by the nature of the complaints, one of which involved a doctor terminating a patient’s ongoing care after that patient was no longer covered by private insurance and was placed on Medicare instead.
U.S. Virgin Islands law requires doctors to provide care to Medicaid and Medicare patients. Here is an excerpt of the law:
All health care providers who, in addition to their employment with the Government of the Virgin Islands, engage in a private practice and receive financial assistance toward the payment of their medical malpractice insurance premiums under this section, shall accept Medicare and Medicaid for payment of health care services from patients in their private practice, and in addition must provide medical services to veterans of the United States Military Services that are covered by an insurance carrier.
As the Attorney General went on to say, the words contained in the statute are clear in their meaning—that doctors must accept Medicaid and Medicare patients into their care. There are no exceptions from this obligation in the U.S. Virgin Islands.
Doctor participation rate in Medicaid often subject to criticism
This is far from the first time the Medicaid program has seen some controversy over doctor participation. In fact, one of the most common criticisms of the program is that the rate of physician participation is lower than the rate for beneficiaries of Medicare. Some imply the Patient Protection and Affordable Care Act of 2010 has made access to Medicaid worse for the people who need it. However, there are some additional factors to take into consideration:
- Federal statistics show the percentage of doctors accepting new Medicaid patients has remained steady at around 70 percent, with no evidence for decline under the ACA.
- Doctor participation rates only measure patient care to a certain extent. One also should consider the number of doctors and their geographic distribution.
- Participations vary from jurisdiction to jurisdiction, and mostly based on reimbursement rates.
- Studies show beneficiaries of Medicaid fare as well as most privately insured people on certain important measures of care access.
Generally, while there may be a lot of excuses raised about low levels of doctor participation, these excuses are tenuous at best. Physicians in the U.S. Virgin Islands are expected to follow the law regarding admittance of Medicaid and Medicare patients.
For more information on the legal aspects of this public policy issue, speak with a knowledgeable government relations attorney.
Tom Bolt is Managing Attorney and Chair of the Government Relations Practice Group at BoltNagi, a widely respected and established government relations law firm serving individuals and businesses throughout the U.S. Virgin Islands.