Table 2.

Interview Themes related to Factors Influencing PCPs’ Decision-Making on Acceptance of Medicaid Patients

Influence Theme	Illustrative Quotes
Provider level
Illness burden and psychosocial needs of prospective Medicaid patients	“There are days when we’ll look at each other and it’s like, ‘I think we’ve got enough people like that.’ It’s like the person who takes the energy of dealing with six ordinary people.”  -PCP in rural health clinic
Practice level
Practice capacity	“It has to do with what our capacity is. So looking at schedules, looking at next appointments, are we able to adequately care for the patients that we ’re currently responsible for?”  -PCP in urban free/low-cost clinic
Health system level
Resources and administrative structures, including specialist availability	“While our ability to care for [Medicaid patients] has dramatically expanded, our ability to tap into our disjointed healthcare system in terms of specialty care maybe hasn’t changed a whole lot … private specialists don’t really care if they ’re uninsured or if they have Healthy Michigan.”  -PCP in urban federally qualified health center “I think the actual decision as to whether to accept Healthy Michigan patients … is made at the health system level … I wouldn’t really be involved in making that decision, nor would most of my clinic leadership.”  -PCP in urban hospital-based practice
Policy environment
Knowledge and attitudes toward reimbursement	“For our clinic, [reimbursement amount] plays no role in whether we accept more Medicaid patients … we ’re gonna serve that population and take care of them … We ’ll do whatever reasonably we can do to get paid for that, but that doesn’t make or break the decision …”  -PCP in urban free/low-cost clinic “If they were to all of a sudden say, ‘Okay, we ’re only going to reimburse 40% or 50% of what we used to,’ that would be enough to put me out of business. So I would think twice about seeing those patients then, but as long as they continue the way they have been for the last six years that I’ve owned the clinic, I don’t see making any changes.”  -PCP in rural health clinic