Medicaid MCOs don't boost care access for the disabled or lower Medicaid expenditures
The type of Medicaid program available to adults with disabilities (AWDs) depends on the State and county of residence. Currently, State Medicaid spending accounts for 22.9 percent of total State expenditures, more than spending on elementary and secondary education. Medicaid managed care organizations (MCOs) were created in the belief that they would improve care while holding down costs. Yet two recent studies by Harvard Medical School researcher Marguerite E. Burns, Ph.D., found little or no benefit from voluntary or mandatory enrollment of adult Medicaid patients with disabilities in MCOs. She recommends that to control costs for AWDs and improve their access to care, States investigate other policy and care management tools beyond MCOs alone. The studies, described here, were funded in part by the Agency for Healthcare Research and Quality (T32 HS00083).
Burns, M. E. (2009). "Medicaid managed care and health care access for adult beneficiaries with disabilities." HSR: Health Services Research 44(5 Part I), pp. 1521-1541.
This study found that patients in mandatory Medicaid MCOs were more likely to experience delays in care than similar patients enrolled in Medicaid fee-for-service (FFS) or voluntary MCO programs. Enrollees in a mandatory MCO program were 24.9 percent more likely to wait more than 30 minutes to see a health care provider than enrollees in Medicaid FFS plans. The mandatory MCO beneficiaries were also 32 percent more likely to report a problem in getting to see a specialist and were 10 percent less likely to have received a flu shot in the past year. The findings were based on analysis of data from the Household Component of the Medical Expenditure Panel Survey (1996-2004) and county-by-county program information from the Centers for Medicare & Medicaid Services. Individuals studied were AWDs (aged 18 to 64), who participated in the Federal Supplementary Security Income program for individuals with disabilities.
Burns, M. E. (2009). "Medicaid managed care and cost containment in the adult disabled population." Medical Care 47(10), pp. 1069-1076.
This study revealed that the cost of monthly Medicaid expenditures for adult Medicaid patients did not differ between counties with FFS or MCO plans. The author investigated total monthly Medicaid expenditures for AWDs in the three types of Medicaid programs. Approximately 50 percent of the persons in the study were from counties with FFS programs, 20 percent from counties with mandatory MCO programs, and 30 percent from counties with voluntary MCOs (patients had an option of FFS or MCO coverage).
Both FFS and mandatory MCO programs had mean unadjusted monthly expenditures of around $440 per beneficiary, while counties that offered voluntary MCOs spent around $600 per beneficiary each month. In adjusted analyses, beneficiaries in mandatory MCO counties had a lower probability of emergency room use than those in FFS counties; however, it did not result in lower average spending for MCO beneficiaries relative to FFS beneficiaries.
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