TL;DR: As more states move people with disabilities to Medicaid managed care, it is critically important to address identified issues for a population that often experiences substantial health disparities and a smaller margin of health.
Abstract: Background: States are increasingly turning to managed care arrangements to control costs in their Medicaid programs. Historically, such arrangements have excluded people with disabilities who use long-term services and supports (LTSS) due to their complex needs. Now, however, some states are also moving this population to managed care. Little is known about the experiences of people with disabilities during and after this transition. Objective: To document experiences of Medicaid enrollees with disabilities using long-term services and supports during transition to Medicaid managed care in Kansas. Methods: During the spring of 2013, 105 Kansans with disabilities using Medicaid long-term services and supports (LTSS) were surveyed via telephone or in-person as they transitioned to managed care. Qualitative data analysis of survey responses was conducted to learn more about the issues encountered by people with disabilities under Medicaid managed care. Results: Respondents encountered numerous disability-related difficulties, particularly with transportation, durable medical equipment, care coordination, communication, increased out of pocket costs, and access to care. Conclusions: As more states move people with disabilities to Medicaid managed care, it is critically important to address these identified issues for a population that often experiences substantial health disparities and a smaller margin of health. It is hoped that the early experiences reported here can inform policy-makers in other states as they contemplate and design similar programs. 2015 Elsevier Inc. All rights reserved.
TL;DR: The ACA was intended to expand access to insurance coverage, not necessarily meet all health care related needs for people with disabilities, but many barriers remain to accessing needed care for this population, regardless of insurance status.
Abstract: Background Although health insurance gains are documented, little is known about personal experiences of adults with disabilities in accessing health care after coverage expansions of the Affordable Care Act (ACA) in 2014. Objective/Hypothesis We interviewed 22 adults across the U.S. with a variety of disabilities and health insurance types to document remaining barriers to health care after ACA coverage expansions. Methods Telephone interviews were conducted from May to August 2017. Participants were recruited via disability-related organizations and were demographically and geographically diverse. Content analysis of interview transcripts was used to identify major themes related to accessing health care. Results Five major themes emerged: 1) information and understanding of coverage; 2) out-of-pocket costs; 3) prescription medications; 4) provider networks; and 5) transportation. Barriers in these areas led participants to delay or forgo health care and interfered with their ability to participate in paid employment. Conclusions The ACA was intended to expand access to insurance coverage, not necessarily meet all health care related needs for people with disabilities. Many barriers remain to accessing needed care for this population, regardless of insurance status. Limited prescription coverage, limited provider networks and steep out-of-pocket costs may be addressed by policy makers at the state or national level. Similarly, having timely and accurate plan information is important in facilitating access to care and insurers should be aware that outdated information can result in missed care. Finally, transportation to appointments can be especially challenging for people with disabilities and insurers should consider options to address this issue.
TL;DR: This study describes MLTSS implementation in Kansas for adults with IDD and identifies key aspects of the Centers for Medicare and Medicaid Services' newMLTSS regulations in the design and implementation of MLTSs programs.
Abstract: Many adults with intellectual and/or developmental disabilities (IDD) can access health and long-term services and supports (LTSS) through Medicaid. States are reforming their Medicaid LTSS programs from a fee-for-service model to a Medicaid managed LTSS (MLTSS) approach, anticipating improved quality of care and reduced costs, although there is limited evidence of MLTSS effectiveness. This study's objective was to contribute to the growing MLTSS research literature by describing MLTSS implementation in Kansas for adults with IDD. Thirty-one stakeholders completed in-depth semi-structured interviews, representing state or regional groups, service coordination providers, and family caregivers. Findings identify key aspects of the Centers for Medicare and Medicaid Services' new MLTSS regulations in the design and implementation of MLTSS programs.
TL;DR: Perceptions of health and healthcare of people with intellectual and developmental disabilities receiving Medicaid Managed Care are examined, with implications for improving healthcare and communications between people with IDD and healthcare providers.
Abstract: This study examined perceptions of health and healthcare of people with intellectual and developmental disabilities (IDD) receiving Medicaid Managed Care. Exploratory, semistructured interviews were conducted with 23 participants. Findings indicate that participants generally expressed being in good health and defined good health as (a) absence of pain, disease, and symptoms; (b) adherence to or not requiring treatment; (c) physical self-care; (d) mental or spiritual self-care; and (e) ability to perform the activities one wants to do. Participants conceptualized healthcare as (a) ensuring needs are met through access to services, (b) obtaining quality services, (c) navigating the healthcare system successfully, and (d) receiving humanizing healthcare. This study has implications for improving healthcare and communications between people with IDD and healthcare providers.
TL;DR: Results of the difference-in-differences (DID) regression analysis suggest that there were no significant state Medicaid cost savings in transitioning people with IDD from FFS to MMC.
Abstract: States have increasingly transitioned Medicaid enrollees with disabilities from fee-for-service (FFS) to Medicaid Managed Care (MMC), intending to reduce state Medicaid spending and to provide better access to health services. Yet, previous studies on the impact of MMC are limited and findings are inconsistent. We analyzed the impact of MMC on costs by tracking Illinois's Medicaid acute health services expenditures for adults with intellectual and developmental disabilities (IDD) living in the community (n = 1,216) before and after their transition to MMC. Results of the difference-in-differences (DID) regression analysis using an inverse propensity score weight (IPW) matched comparison group (n = 1,134) design suggest that there were no significant state Medicaid cost savings in transitioning people with IDD from FFS to MMC.
TL;DR: The authors delineate analytic procedures specific to each approach and techniques addressing trustworthiness with hypothetical examples drawn from the area of end-of-life care.
Abstract: Content analysis is a widely used qualitative research technique. Rather than being a single method, current applications of content analysis show three distinct approaches: conventional, directed, or summative. All three approaches are used to interpret meaning from the content of text data and, hence, adhere to the naturalistic paradigm. The major differences among the approaches are coding schemes, origins of codes, and threats to trustworthiness. In conventional content analysis, coding categories are derived directly from the text data. With a directed approach, analysis starts with a theory or relevant research findings as guidance for initial codes. A summative content analysis involves counting and comparisons, usually of keywords or content, followed by the interpretation of the underlying context. The authors delineate analytic procedures specific to each approach and techniques addressing trustworthiness with hypothetical examples drawn from the area of end-of-life care.
"Medicaid managed care: Issues for b..." refers methods in this paper
...A researcher trained in qualitative methods who did not administer surveys analyzed the open-ended response data using conventional content analysis, a methodology that requires researchers to immerse themselves in data and allows codes, categories and themes to emerge.(17,18) The researcher initially read data, identified pertinent areas of text, pile sorted areas into like categories and used categories to construct codes....
Abstract: In "Writing Ethnographic Fieldnotes", Robert M. Emerson, Rachel I. Fretz, and Linda L. Shaw present a series of guidelines, suggestions, and practical advice for creating useful fieldnotes in a variety of settings, demystifying a process that is often assumed to be intuitive and impossible to teach. Using actual unfinished notes as examples, the authors illustrate options for composing, reviewing, and working fieldnotes into finished texts. They discuss different organizational and descriptive strategies and show how transforming direct observations into vivid descriptions results not simply from good memory but from learning to envision scenes as written. A good ethnographer, they demonstrate, must learn to remember dialogue and movement like an actor, to see colors and shapes like a painter, and to sense moods and rhythms like a poet. This new edition reflects the extensive feedback the authors have received from students and instructors since the first edition was published in 1995. As a result, they have updated the race, class, and gender section, created new sections on coding programs and revising first drafts, and provided new examples of working notes. An essential tool for budding social scientists, the second edition of "Writing Ethnographic Fieldnotes" will be invaluable for a new generation of researchers entering the field.
TL;DR: Young adults perceive the new tobacco products positively and are willing to experiment with them, and Eliminating flavors in these products may reduce young adults' intentions to try these products.
Abstract: Objectives. We explored young adults’ perceptions of snus (spitless moist snuff packed in porous bags), dissolvable tobacco products, and electronic cigarettes and intention to try these products.Methods. We conducted 11 focus group discussions involving a total of 66 young adults (18–26 years old) on these new tobacco products (e.g., harmfulness, potential as quit aids, intention to try) held between July and December 2010. We analyzed discussions using a thematic approach.Results. Participants generally reported positive perceptions of the new products, particularly because they came in flavors. Few negative perceptions were reported. Although some participants believed these products were less harmful than cigarettes and helpful in quitting smoking, others thought the opposite, particularly regarding electronic cigarettes. Participants also commented that these products could be gateways to cigarette smoking. Half of the participants, including a mix of smokers and nonsmokers, admitted they would try t...
TL;DR: Head Start program directors face difficulty in implementing policies and practices to address obesity-and in a national survey, they identified the key barriers as lack of time, money, and knowledge.
Abstract: Head Start provides early childhood education to nearly one million low-income children, through federal grants to more than 2,000 local programs. About one-third of children who enter Head Start are overweight or obese. But program directors face difficulty in implementing policies and practices to address obesity—and in our national survey, they identified the key barriers as lack of time, money, and knowledge. Also, parents and staff sometimes shared cultural beliefs that were inconsistent with preventing obesity, such as the belief that heavier children are healthier. Minimizing those barriers will require federal resources to increase staff training and technical assistance, develop staff wellness programs, and provide healthy meals and snacks.