NPs, PAs are essential to build primary care access

Ensuring access to primary care in Medicaid is going to take a "multi-pronged strategy," according to Julia Paradise, MSPH, an associate director of the Kaiser Family Foundation's Kaiser Commission on Medicaid and the Uninsured and lead author of the organization's March 2011 brief, Improving Access to Adult Primary Care in Medicaid.

"This includes more fully deploying all our primary care providers — nurse practitioners and physician's assistants, as well as doctors," she says.

Ms. Paradise notes that an October 2010 Institute of Medicine report, The Future of Nursing: Leading Change, Advancing Health, documented the high quality of care provided by nurse practitioners, and recommended state and federal actions to clear the way for them to practice to the full extent of their training.

In light of this, says Ms. Paradise, states can free up additional primary care supply in the immediate term by removing restrictive scope-of-practice regulations that many have on the books.

"We have great examples of high-performing health care systems, including the VA health system and the Geisinger Health System, in which nurse practitioners are integral to the delivery of primary care," says Ms. Paradise.

Ms. Paradise adds that the concern about access to primary care in Medicaid is "one facet of the bigger reality — that we need a larger primary care workforce than we currently have."

The maldistribution of health resources compounds this problem for low-income communities, says Ms. Paradise, because there are more providers than needed in some geographic areas and serious shortages in others.

"Increased support for primary care providers who participate in Medicaid is one lever for securing more capacity in the program," says Ms. Paradise. "The two-year boost in Medicaid payment rates for primary care physicians, as provided by the health reform law, speaks directly to that."

Contact Ms. Paradise at (202) 347-5270 or