In the Journals

With drastic reforms looming, Medicaid enrollees mostly satisfied with care

While the future of the program is in doubt in the current health care legislation debate, across various demographic groups and state expansion choices, individuals enrolled in Medicaid were generally satisfied with their experience in the program and were largely able to access essential care, according to a survey analysis published in JAMA Internal Medicine.

“In the current debate over the Affordable Care Act (ACA), some policymakers have argued that Medicaid is a broken program that provides enrollees with inadequate access to physicians,” Michael L. Barnett, MD, MS, and Benjamin D. Sommers, MD, PhD, both from the Harvard T.H. Chan School of Public Health, wrote. “While numerous studies demonstrate that Medicaid increases access to care, the literature has less frequently focused on patient satisfaction among Medicaid enrollees themselves.”

Barnett and Sommers used data from the first national Medicaid Consumer Assessment of Healthcare Providers and System survey that was administered by the CMS in 46 states and Washington, D.C., to examine Medicaid beneficiaries’ experiences in the program (n = 272,679). The CMS sampled four groups of adults who were enrolled in Medicaid as of fall 2013, including disabled adults, individuals enrolled in both Medicaid and Medicare, patients in managed care without disabilities and those in fee-for-service medical care without disabilities, between December 2014 and July 2015. Participants reported their overall health care rating on a scale of 0 (“the worst health care possible”) to 10 (“the best health care possible”). The researchers stratified the outcome by age, race, sex, eligibility group and state Medicaid expansion status.

On average, Medicaid enrollees rated their health care as a score of 7.9. Nearly half of participants (46%) rated their Medicaid coverage with scores of 9 or 10. Scores lower than 5 were reported by only 7.6%. Medicaid expansion and nonexpansion states reported similar ratings (7.8 vs. 7.9). Older adults and dual-eligible beneficiaries demonstrated slightly higher ratings, while individuals in fee-for-service and managed care showed similar ratings. Across all demographic groups, there was a variation in ratings from 7.6 to 8.3.

Access to necessary care in the past 6 months was reported by 84% of participants. In addition, having a usual source of care was reported by 83%. In Medicaid expansion states, there was a significantly higher mean percentage of beneficiaries able to access all necessary care compared with nonexpansion states (85.2% vs. 81.5%; P < .001). Wait times and physicians not accepting certain insurance were barriers to access of care for only 3% of participants.

“While limited by its response rate and use of pre-ACA enrollment to define the sample, this data set offers important advantages,” Barnett and Sommers concluded. “First, its sample was drawn from official Medicaid enrollment files, so it does not rely on often inaccurate self-reporting of insurance coverage as in other surveys. Second, it has a much larger sample size of Medicaid enrollees than many similar surveys.”

Changes to Medicaid that would result in millions of beneficiaries losing coverage could have major adverse effects,” they concluded. – by Alaina Tedesco

Disclosure: Barnett and Sommers report no relevant financial disclosures.

 

While the future of the program is in doubt in the current health care legislation debate, across various demographic groups and state expansion choices, individuals enrolled in Medicaid were generally satisfied with their experience in the program and were largely able to access essential care, according to a survey analysis published in JAMA Internal Medicine.

“In the current debate over the Affordable Care Act (ACA), some policymakers have argued that Medicaid is a broken program that provides enrollees with inadequate access to physicians,” Michael L. Barnett, MD, MS, and Benjamin D. Sommers, MD, PhD, both from the Harvard T.H. Chan School of Public Health, wrote. “While numerous studies demonstrate that Medicaid increases access to care, the literature has less frequently focused on patient satisfaction among Medicaid enrollees themselves.”

Barnett and Sommers used data from the first national Medicaid Consumer Assessment of Healthcare Providers and System survey that was administered by the CMS in 46 states and Washington, D.C., to examine Medicaid beneficiaries’ experiences in the program (n = 272,679). The CMS sampled four groups of adults who were enrolled in Medicaid as of fall 2013, including disabled adults, individuals enrolled in both Medicaid and Medicare, patients in managed care without disabilities and those in fee-for-service medical care without disabilities, between December 2014 and July 2015. Participants reported their overall health care rating on a scale of 0 (“the worst health care possible”) to 10 (“the best health care possible”). The researchers stratified the outcome by age, race, sex, eligibility group and state Medicaid expansion status.

On average, Medicaid enrollees rated their health care as a score of 7.9. Nearly half of participants (46%) rated their Medicaid coverage with scores of 9 or 10. Scores lower than 5 were reported by only 7.6%. Medicaid expansion and nonexpansion states reported similar ratings (7.8 vs. 7.9). Older adults and dual-eligible beneficiaries demonstrated slightly higher ratings, while individuals in fee-for-service and managed care showed similar ratings. Across all demographic groups, there was a variation in ratings from 7.6 to 8.3.

Access to necessary care in the past 6 months was reported by 84% of participants. In addition, having a usual source of care was reported by 83%. In Medicaid expansion states, there was a significantly higher mean percentage of beneficiaries able to access all necessary care compared with nonexpansion states (85.2% vs. 81.5%; P < .001). Wait times and physicians not accepting certain insurance were barriers to access of care for only 3% of participants.

“While limited by its response rate and use of pre-ACA enrollment to define the sample, this data set offers important advantages,” Barnett and Sommers concluded. “First, its sample was drawn from official Medicaid enrollment files, so it does not rely on often inaccurate self-reporting of insurance coverage as in other surveys. Second, it has a much larger sample size of Medicaid enrollees than many similar surveys.”

Changes to Medicaid that would result in millions of beneficiaries losing coverage could have major adverse effects,” they concluded. – by Alaina Tedesco

Disclosure: Barnett and Sommers report no relevant financial disclosures.