Engaging Consumers in Medicaid Program Design: Strategies from the States

Zhu, Jane M.; Rowland, Ruth; Gunn, Rose; Gollust, Sarah E.; Grande, David

doi:10.1111/1468-0009.12492

Cited by 2 publications

(2 citation statements)

References 24 publications

(51 reference statements)

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“…Next, we are interviewing patients with Medi-Cal to better understand their care preferences and priorities. Engaging patients provides the opportunity to incorporate community needs and increase participation among an often-ignored population [ 60 ].…”

Section: Discussionmentioning

confidence: 99%

Frontline perspectives on barriers to care for patients with California Medicaid: a qualitative study

Faiz,

Blegen,

Nuñez

et al. 2024

Int J Equity Health

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Background While insurance is integral for accessing healthcare in the US, coverage alone may not ensure access, especially for those publicly insured. Access barriers for Medicaid-insured patients are rooted in social drivers of health, insurance complexities in the setting of managed care plans, and federal- and state-level policies. Elucidating barriers at the health system level may reveal opportunities for sustainable solutions. Methods To understand barriers to ambulatory care access for patients with Medi-Cal (California’s Medicaid program) and identify improvement opportunities, we performed a qualitative study using semi-structured interviews of a referred sample of clinicians and administrative staff members experienced with clinical patient encounters and/or completion of referral processes for patients with Medi-Cal (n = 19) at a large academic medical center. The interview guide covered the four process steps to accessing care within the health system: (1) scheduling, (2) referral and authorization, (3) contracting, and (4) the clinical encounter. We transcribed and inductively coded the interviews, then organized themes across the four steps to identify perceptions of barriers to access and improvement opportunities for ambulatory care for patients with Medi-Cal. Results Clinicians and administrative staff members at a large academic medical center revealed barriers to ambulatory care access for Medi-Cal insured patients, including lack of awareness of system-level policy, complexities surrounding insurance contracting, limited resources for social support, and poor dissemination of information to patients. Particularly, interviews revealed how managed Medi-Cal impacts academic health systems through additional time and effort by frontline staff to facilitate patient access compared to fee-for-service Medi-Cal. Interviewees reported that this resulted in patient care delays, suboptimal care coordination, and care fragmentation. Conclusions Our findings highlight gaps in system-level policy, inconsistencies in pursuing insurance authorizations, limited resources for scheduling and social work support, and poor dissemination of information to and between providers and patients, which limit access to care at an academic medical center for Medi-Cal insured patients. Many interviewees additionally shared the moral injury that they experienced as they witnessed patient care delays in the absence of system-level structures to address these barriers. Reform at the state, insurance organization, and institutional levels is necessary to form solutions within Medi-Cal innovation efforts.

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Section: Discussionmentioning

confidence: 99%

Frontline perspectives on barriers to care for patients with California Medicaid: a qualitative study

Faiz,

Blegen,

Nuñez

et al. 2024

Int J Equity Health

View full text Add to dashboard Cite

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“…These studies highlight that the typical model of MMC, in which the burden of education, awareness, and decision-making falls on enrollees who are often not empowered with knowledge or access to resources, may not best serve MMC recipients [18]. Instead, collaborations between state Medicaid programs, MCOs, and Medicaid recipients to provide input on consumer education and engagement and product rollout strategies seem more effective [19].…”

Section: Discussionmentioning

confidence: 99%

Perceptions of North Carolina’s Medicaid Transformation: A Qualitative Study

Zimmer,

Hanchate,

Palakshappa

et al. 2023

North Carolina Medical Journal

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Background In 2021, North Carolina switched 1.6 million beneficiaries from a fee-for-service Medicaid model to a managed care system. The state prepared beneficiaries with logistical planning and a communications plan. However, the rollout occurred during the COVID-19 pandemic, creating significant challenges. Little is known about how Medicaid Transformation impacted the experience of Medicaid enrollees. Methods We conducted four focus groups (N = 22) with Medicaid beneficiaries from January to March 2022 to gain insight into their experience with Medicaid Transformation. A convenience sample was recruited. Focus groups were recorded, transcribed verbatim, and verified. A codebook was developed using inductive and deductive codes. Two study team members independently coded the transcripts; discrepancies were resolved among the research team. Themes were derived by their prevalence and salience within the data. Results We identified four major themes: 1) Participants expressed confusion about the signup process; 2) Participants had a limited understanding of their new plans; 3) Participants expressed difficulty accessing services through their plans; and 4) Participants primarily noted negative changes to their care. These findings suggest that Medicaid enrollees felt unsupported during the enrollment process and had difficulty accessing assistance to gain a better understanding of their plans and new services. Limitations Participants were recruited from a single institution in the Southeastern United States; results may not be transferable to other institutions. Participants were likely not representative of all Medicaid Transformation beneficiaries; only English-speaking participants were included. Conclusion As the transition process continues, the North Carolina Medicaid program can benefit from integrating recommendations identified by member input to guide strategies for addressing whole-person care.

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Engaging Consumers in Medicaid Program Design: Strategies from the States

Cited by 2 publications

References 24 publications

Frontline perspectives on barriers to care for patients with California Medicaid: a qualitative study

Frontline perspectives on barriers to care for patients with California Medicaid: a qualitative study

Perceptions of North Carolina’s Medicaid Transformation: A Qualitative Study

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