Medicaid managed care and health care access for adult beneficiaries with disabilities.

Department of Ambulatory Care and Prevention, Harvard Medical School, Harvard Pilgrim Health Care, Boston, MA 02215, USA.
Health Services Research (Impact Factor: 2.49). 06/2009; 44(5 Pt 1):1521-41. DOI: 10.1111/j.1475-6773.2009.00991.x
Source: PubMed

ABSTRACT To evaluate the impact of Medicaid managed care organizations (MCO) on health care access for adults with disabilities (AWDs).
Mandatory and voluntary enrollment data for AWDs in Medicaid MCOs in each county were merged with the Medical Expenditure Panel Survey and the Area Resource File for 1996-2004.
I use logit regression and two evaluation perspectives to compare access and preventive care for AWDs in Medicaid MCOs with FFS. From the state's perspective, I compare AWDs in counties with mandatory, voluntary, and no MCOs. From the enrollee's perspective, I compare AWDs who must enroll in an MCO or FFS to those who may choose between them.
Mandatory MCO enrollees are 24.9 percent more likely to wait >30 minutes to see a provider, 32 percent more likely to report a problem accessing a specialist, and 10 percent less likely to receive a flu shot within the past year. These differences persist from the state evaluation perspective.
States should not expect a dramatic change in health care access when they implement Medicaid MCOs to deliver care to the adult disabled population. However, continued attention to specialty care access is warranted for mandatory MCO enrollees.

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    ABSTRACT: People with disabilities (PWD) are more likely than those without disabilities to experience barriers when accessing healthcare, often leading to unmet needs. The chasm between what providers perceive as adequate care for PWD and the actual health care needs as perceived by PWD remains significant. Using data from 360 health care providers and 540 Medicaid eligible PWD, we compared perceived barriers to care faced by PWD from the perspective of both providers and PWD. Our results indicated major variations in provider and PWD perceptions about barriers to care. PWD and providers both perceived transportation issues as the highest ranked barriers and physical access issues as the lowest ranked barriers. Multivariate results indicated that PWD reported barriers when communicating with providers, although providers did not consider communication as a major barrier. Among PWD, those with multiple types of disabilities were more likely to experience barriers when communicating with providers compared with other PWD. In addition, providers considered insurance a barrier to care, although this was not the perception of PWD. Particularly in the era of health care reform, policy responses to these findings should address the specific needs of people with different types of disabling conditions rather than assuming all PWD face similar challenges in accessing and utilizing health care.
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    ABSTRACT: Background States are increasingly turning to managed care arrangements to control costs in their Medicaid programs. Historically, such arrangements have excluded people with disabilities who use long-term services and supports (LTSS) due to their complex needs. Now, however, some states are also moving this population to managed care. Little is known about the experiences of people with disabilities during and after this transition. Objective To document experiences of Medicaid enrollees with disabilities using long-term services and supports during transition to Medicaid managed care in Kansas. Methods During the spring of 2013, 105 Kansans with disabilities using Medicaid long-term services and supports (LTSS) were surveyed via telephone or in-person as they transitioned to managed care. Qualitative data analysis of survey responses was conducted to learn more about the issues encountered by people with disabilities under Medicaid managed care. Results Respondents encountered numerous disability-related difficulties, particularly with transportation, durable medical equipment, care coordination, communication, increased out of pocket costs, and access to care. Conclusions As more states move people with disabilities to Medicaid managed care, it is critically important to address these identified issues for a population that often experiences substantial health disparities and a smaller margin of health. It is hoped that the early experiences reported here can inform policy-makers in other states as they contemplate and design similar programs.
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