The effects of expanded nurse practitioner and physician assistant scope of practice on the cost of Medicaid patient care

•Allowing physician assistants to prescribe controlled substances reduces outpatient care cost.•This reduction is quite large, ranging from 11.8% to 16.0%.•This change is not associated with any changes in care intensity.

The provision of health care to low-income Americans remains an ongoing policy challenge. In this paper, I examine how important changes to occupational licensing laws for nurse practitioners and physician assistants have affected cost and intensity of health care for Medicaid patients. The results suggest that allowing physician assistants to prescribe controlled substances is associated with a substantial (more than 11%) reduction in the dollar amount of outpatient claims per Medicaid recipient. I find little evidence that expanded scope of practice has affected proxies for care intensity such as total claims and total care days. Relaxing occupational licensing requirements by broadening the scope of practice for healthcare providers may represent a low-cost alternative to providing quality care to America’s poor.