Safety-Net Institutions Buffer the Impact of Medicaid Managed Care: A Multi-Method Assessment in a Rural State

Abstract

In its first year, Medicaid managed care exerted major effects on safety-net providers but relatively few measurable effects on individuals. This reform did not address the problems of the uninsured.

The Impact of Insurance Lapse among Low-Income Children

“…Among low-income families, the uninsured were less likely to obtain preventive health care services, 39 but findings from this study corroborate others indicating that even temporary lapses of coverage are associated with poorer health care access. 2,3 Preventive care visits also were associated with the caregivers' better perception of the family's financial situation (Financial Situation QOLI score). Poor financial situation or poverty has been linked to disproportionately more health problems and disproportionately poorer preventive health care utilization in children.…”

“…1 Children in low-income families are at greater risk than children in higher income families for being uninsured as well as for experiencing lapses in their insurance coverage. 2 For many low-income children, Medicaid has served as the health care safety net, ensuring their access to preventive and other health care in the absence of other health coverage. Still, an estimated 6.5 million children who are eligible for Medicaid are uninsured.…”

“…1 Lack of coverage, whether long term or temporary, is associated with poorer health care access. 2,3 Studies have found that with both Spanish-and English-speaking low-income families, children who were privately insured or continuously insured by Medicaid had far better health care utilization and access than did children with episodic Medicaid coverage or no insurance. 2,4 In fact, Latino children with episodic Medicaid coverage demonstrated similar patterns of overall visits, use of public clinics, and fragmented continuity of care when compared to those with no insurance at all.…”

“…7 Providers also encountered obstacles with authorization processes for Medicaid eligibility, becoming accustomed to changes in paperwork, and delayed reimbursement for treatment. 2 Other areas of confusion included default assignments into a Medicaid managed-care plan even when a parent reported completing the forms; default assignments within a single family were inconsistent; and some disenrollment procedures took months to accomplish (meanwhile, the child either could not be seen for the appointment or, if the child was seen, the PCP was not paid by the newly assigned plan). It is unclear how many Medicaid recipients had delays in care or were lost to the program because of the confusion and barriers presented by the transition to managed care.…”

“…One study found that the transition from fee-for-service to managed care did not influence the care of most recipients, with the notable exceptions of those living in rural areas, those who needed mental health services, and those who received prescriptions for drugs not included on the managed-care organization's formulary. 2 …”