The Next Challenge for Expanded Medicaid: Accessing Care

Sep 17, 2019


Since Medicaid expanded, Sentara Norfolk General Hospital has seen a 3.5-percent uptick in Medicaid charges, and a corresponding decrease in uninsured patients.
Credit Mallory Noe-Payne / RADIOIQ

More than 300,000 Virginians have something today they didn’t have this time last year -- health insurance through Medicaid. Lawmakers lowered the requirements for the state-run health insurance program in January. 

But just because someone has health insurance, doesn’t mean they’re accessing healthcare. We take a look at how Medicaid expansion is going, nine months in. 


Sentara Norfolk General Hospital is a Level 1 Trauma center, one of the largest in the state. It has more than 500 beds. 

In this area more than 70,000 people have signed up for Medicaid since January. And they’re coming through the hospital doors, says Norfolk General President Carolyn Carpenter. 

She says a 1-percent increase in Medicaid patients would be significant. They’ve seen a 3.5-percent increase. 

“And at the same time the wonderful thing is we see the category that we call self-pay is going down,” Carpenter says. “And so we know that we usually sit in about the 8-percent and we’re down to about 5-percent.”

That means capacity hasn’t been a challenge. What has been a challenge is where people are showing up at the hospital. This year, visits to the emergency room have increased by 7-percent. 

“Unfortunately often the behavior is I show up, I get care,” Carpenter says. “So I show up at a clinic, I show up at an emergency department, and I generally show up when I’m pretty desperate and in need of that care.” 

"We have some folks who we're getting them right in, we're making appointments for them. We've had others who've struggled to get appointments."

Studies from other states show that after Medicaid was expanded, visits to the emergency department increased. The ED is one of the most expensive ways to access healthcare. 

So the hurdle is teaching people, now that they have insurance, that they can get a primary care doctor and come in for regular check-ups. 

“That’s a whole behavior modification and teaching and education that needs to happen,” says Carpenter. 

That education component has fallen largely to insurance providers.

Six of them, including big names like Anthem and Aetna, divvy up new Medicaid enrollees. They distribute insurance cards, assign primary care doctors, and then, connect over the phone.

Randy Ricker runs Medicaid for Optima health insurance. The company has taken on about 53,000 new customers from expansion, all over the state. They’ve successfully connected with about 70-percent of them by phone. 

“We have some folks who we’re getting them right in, we’re making appointments for them. We’ve had others who’ve struggled to get appointments,” says Ricker. 

While it’s too soon to have specific numbers, anecdotally Ricker says the struggles have been limited to certain parts of the - in southwest, and some parts of central Virginia. 

"I can't make you go to the doctor. But we sure can make it so that the card means something."

But that’s just the experience of one of the six health insurance providers. Numbers from the Department of Medical Assistance Services, or DMAS, show that people are accessing care. 


As of the end of July, more than 100,000 people had gotten a prescription filled, almost 19,000 treated for diabetes, and more than 16,000 treated for substance use disorder. In total more than 250,000 of the enrolles have used their new insurance card.

“That’s the dream, that’s the dream! For me, and I’ve worked very hard for this, I mean you want people to have access,” says DMAS’ Cheryl Roberts. “I can’t make you go to the doctor. But we sure can make it so that the card means something. 

A report released this week by the Joint Legislative Audit and Review Commission shows access, measured by distance to the closest in-network doctor,  is strong for primary care, pediatrics, and OBGYNs. 

But there are shortages in specialties, like kidney doctors and psychiatrists. 

Roberts points out those shortages aren’t specific to Medicaid, but mirror the healthcare system overall. 

She predicts more people with health insurance won’t exacerbate that issue, but actually ease it. When people can access preventative care, it will mean they may not wind up needing a specialist.

“Something as simple as taking blood pressure medicine so you don’t have the heart attack or the stroke,” Roberts says. “I’m hoping we have a healthier Virginia.”


This is part one in a look at Medicaid expansion, part two airs Wednesday.

 This report, provided by Virginia Public Radio, was made possible with support from the Virginia Education Association.