As millions of Ohioans, including thousands in the Toledo area, consider enrolling in Medicaid during the second enrollment period of the Affordable Care Act, some doctors are still hesitant to accept new Medicaid patients and some are concerned the program may lose a key incentive for them to accept those patients.

There are more than 2.8 million people in the Ohio Medicaid system, which provides health care for low-income residents. In Ohio, 430,942 of those Medicaid beneficiaries became newly eligible for coverage on Jan. 1, said Samuel Rossi, spokesman for Medicaid Ohio.

Even as the Affordable Care Act provided additional funding to states to increase the numbers of uninsured eligible for health care through Medicaid, concern has grown among some people in the health-care community that not enough family doctors will take on new patients with Medicaid health coverage.

Dr. William Feeman, Jr., who has operated a family medical practice in Bowling Green for more than 40 years, said he is leery of taking new patients with Medicaid insurance plans.

He said there is the traditional state-run Medicaid that reimburses doctors for services and has been operating for years. There are also new private insurance companies that are contracting with the state to provide health care for low-income patients.

The Ohio Medicaid managed-care plans are Buckeye Health Plan, Caresource, Molina Healthcare, Paramount Advantage, and the United Healthcare Community Plan.

“I take the state Medicaid, but I don’t take Buckeye Medicaid because they don’t pay anything,” Dr. Feeman said.

He said many doctors are worried about reimbursements and other perceived problems when dealing with health-care companies that cover Ohio’s low-income residents. One of the concerns he expressed is that it can be difficult to get approval from some of the Medicaid managed-care plans for patients to take tests that doctors believe are routine.

“I have one patient who is a good patient. When she had money she always paid her bills. She is on United Medicaid. They pay a little bit, but I’m not deserting her. We’ve turned down other people from that company,” he said.

According to Mr. Rossi, Ohio’s Medicaid department cannot provide The Blade with information on how much each of these managed-care companies pays doctors for providing different services.

“The five Medicaid managed-care plans negotiate their respective rates with their individual provider networks,” he said.

Dr. Feeman said he is concerned that these health insurance companies are trying to save money and cut health-care costs by denying benefits or making it extremely difficult for Medicaid patients to receive diagnostic services.

Miranda Motter, president and CEO of the Ohio Association of Health Plans, said the Medicaid providers that her group represents have a goal of providing care, “in the right amount to attain and maintain an individual’s optimal health.”

Ms. Motter said further in a written statement that “in regard to prior authorization of services, health plans utilize nationally accepted, evidence-based protocols and standards for review and approval of services that require prior authorization. All health-care services delivered under the Medicaid program, whether via traditional Medicaid or through a managed-care plan, must meet a standard of medical necessity.”

“We do know that the reimbursement rate here in Ohio is a major factor for physicians in Ohio when deciding how many patients to take,” said Reginald Fields, spokesman for the Ohio State Medical Association, which represents about 20,000 physicians.

The medical association found that about 40 percent of its members, who responded to a recent survey, said they are currently accepting new Medicaid patients into their practice. About 600 of the group’s 20,000 members responded to the survey.

Although there are some doctors in Ohio who do accept Medicaid insurance plans, the pool of willing physicians could get smaller next year because reimbursements may get even lower.

Historically, doctors were paid much less by the federal government for treating Medicaid patients than they were for treating those on Medicare.

The average Medicaid reimbursement in Ohio was 59 cents for every dollar paid on Medicare claims, Mr. Fields said.

With the passage of the Affordable Care Act the federal government took steps to correct this disparity in a limited way, he said. The law provided for two years of funding to bring Medicaid reimbursements in line with Medicare, but only for general internal medicine, or pediatric medicine and related specialties.

According to the Centers for Medicare and Medicaid Services, the federal government gave states $11 billion in new funds to boost Medicaid reimbursement fees in 2013 and 2014.

Unless there is some action taken at the federal or state level, however, the Medicaid rates paid to family physicians will go back to previous levels beginning Jan. 1. 2015, Mr. Fields said. If this happens, it could have a major impact on those Medicaid patients and local and state health-care systems.

The Medicaid expansion in Ohio made coverage available to households with incomes of up to 135 percent of the federal poverty rate. The vast majority of Lucas County residents who enrolled in health plans through the ACA marketplace exchange in the first year were those who qualified to receive Medicaid based on the expansion.

Those without health care in Lucas County shrank from about 45,000 to approximately 24,000, but a large portion of that group, about 72 percent, were enrolled in Ohio’s Medicaid program. Statewide, about a third of the 483,328 newly insured chose health plans in the marketplace, while some 67 percent were enrolled in Medicaid.

The Kaiser Family Foundation, a Washington-based think tank, recently surveyed states across the country to see which plan to take over the Medicaid parity program when the federal funds run out on Dec. 31.

Michigan is among the 15 or 16 states that have committed to extend the increase in Medicaid benefits, but Ohio has not indicated that it will, said Julia Paradise, spokesman for the research group.

She said physician trade groups are lobbying for states to continue the program on their own but “there is uncertainty all around on this.”

Mr. Fields said his organization would like the state of Ohio or the federal government to make the Medicaid parity with Medicare permanent and to see it extended to more doctors, not just family physicians.

“We would like to see it in the next state budget,” he said. The association hopes this doesn’t lead to doctors dropping patients but financially it will be difficult for them if the Medicaid rates drop, he said.

Ms. Paradise said nationally about two thirds of primary care physicians currently accept Medicaid patients, but that rate is lower than the percent that accept privately insured patients.

“Reimbursement rates and payments are the top reasons that physicians tend to give for not participating in Medicaid,” she said.

Contact Marlene Harris-Taylor at mtaylor@theblade.com or 419-724-6091.

First Published December 1, 2014, 5:00 a.m.