Seniors’ and People with Disabilities’ Experiences with Mandatory Medicaid Managed Care in California: Populations to Target for Additional Support during Transitions

• Published in: Journal of health care for the poor and underserved 2016-11, Vol.27 (4), p.1819-1842
• Main Authors: Graham, Carrie L, McDonnell, Diana D
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Beneficiaries; Biocompatibility; Biomedical materials; California; Cancer; Chronic illnesses; Cognitive ability; Cognitive impairment; Continuity of care; Disabilities; Disabled Persons; Fee-for-Service Plans; Focus groups; Functional impairment; Government programs; Health care policy; Health insurance; Health status; Humans; Hypotheses; Hypothesis testing; Impairment; Managed care; Managed Care Programs; Medicaid; Medicare; Negative experiences; Older people; Osteoarthritis; People with disabilities; Physicians; Population; Populations; Primary care; Quality; Quality of care; Self evaluation; Stakeholders; Studies; United States; Visits
• ISSN: 1049-2089; 1548-6869; 1548-6869
• DOI: 10.1353/hpu.2016.0165

With more states moving people with disabilities and complex care needs into managed care, it is important to target beneficiaries for additional anticipated support before specific needs arise. In a survey of 1,521 seniors and people with disabilities in California who moved into Medicaid managed care six-16 months previously, the majority reported neutral or positive experiences with managed care continuity, access, and quality, compared with fee-for-service. Beneficiaries most likely to have negative experiences included those with poor self-rated health, functional impairment, cognitive impairment, frequent ED visits, and claims for back / osteoarthritis and cancer. Those with no specialty visits and those who had been continuously enrolled in Medicaid longer term before the transition also were more likely to report negative experiences. These populations can be targeted for assistance by health plans and Medicaid agencies. More specialty visits and longer time in Medicaid managed care also seems to improve beneficiaries' experiences.