Advanced Practice Nurses: Willing to Meet the Needs of the Medicaid Expansion

This guest post was written by Donna Petko, MSN(c), BSN, RN; Clinical Director; 1st Choice Home Health Providers, LLC

If Medicaid Eligibility Expansion (HB 6253) is approved in early January 2013, an estimated 342,000 low-income adults in Illinois will become eligible and enrolled in Medicaid over the next four years.  Once these individuals become insured, they are likely to seek out primary care providers.  However, as designated by the United States Department of Health and Human Services, 100 counties in Illinois have been identified as having State Physician and/or Federal Health Professional Shortage areas (Health & Medicine Policy Research Group [HMPRG], 2012).  Who will provide primary health care services to these newly enrolled Illinois residents?

Advanced practice nurses (APNs) are one solution to the growing shortage of primary care physicians (PEW, 1999).  APNs are registered nurses who have advanced knowledge and clinical training, a graduate degree, and hold national certification.  These professionals serve as health care providers in a broad range of primary care, acute care, and outpatient settings.  In Illinois, there are four categories of APNs: certified nurse-midwife (CNM), clinical nurse specialist (CNS), certified nurse practitioner, (CNP) and certified registered nurse anesthetist (CRNA).  Currently, there are more than 7,500 advanced practice nurses in the state of Illinois (HMPRG, 2012).

What do advanced practice nurses do?  APNs diagnose illnesses, prescribe treatments and medications, and provide primary care services in a variety of settings which include hospitals, clinics, community health centers, nursing facilities, and schools (HMPRG, 2012).  According to the Institute of Medicine (IOM) report The Future of Nursing: Leading Change, Advancing Health (2010), APNs increase patient safety, access, and continuity of care.  Data from studies on APNs show that these professionals deliver safe, high-quality primary care services (ANA, 2012). 

In order to meet the growing need for healthcare services within the state, APNs need to practice to the fullest extent of their education and training. How do we increase access to healthcare services for Illinois residents?  By changing the Nurse Practice Act and removing practice barriers: 

• Eliminating the requirement for a written collaborative agreement between physicians and APNs 
• Allowing APNs to participate in the insurance exchange as primary care providers
• Providing APNs with full plenary authority to provide access to Illinois residents needing primary care services (HMPRG, 2012).

Besides providing safe, high-quality healthcare, APNs provide a considerable cost savings as well.  For example, the average cost of a nurse practitioner (NP) visit is between 20-35% less than the average cost of an office-based physician visit (Medical Expenditure Panel Survey, 2010).  Furthermore, malpractice rates of NPs are no higher in states with independent NP practice when compared to those states where collaboration is required for practice (HMPRG, 2012).

In addition to supporting HB 6253, which will allow Illinois to leverage over $5 billion in federal Medicaid funding to provide comprehensive health care coverage to over 342,000 low-income individuals (Becker, 2012), please support advanced practice nurses in their quest to provide better access to healthcare services for Illinois residents.  Because APNs are more likely to work in underserved areas caring for Medicaid beneficiaries than primary care physicians (Grumbach et al., 2003; Kaiser, 2011), the barriers to practice must be removed.

The Illinois General Assembly needs to pass HB 6253 by January 9, 2013, the end of the current legislative session, to ensure programs and systems are in place just 12 months from now, when one of the largest parts of health care reform begins (IHM, 2012).  Once this bill is passed, the only way to ensure better access to care for Illinois residents is by changing the Nurse Practice Act to allow APNs to practice to the fullest extent of their education and training. 

Please continue to support this common-sense, fiscally sound legislation in Illinois.  To find out who your legislators are, go to the Illinois State Board of Elections Search Page. Please share this message and urge your friends and family members to tell their legislators to support these efforts between now and January 9, 2013. For more info, read this fact sheet from Health & Medicine Policy Research Group.