Medicaid managed care: Issues for beneficiaries with disabilities
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.
About: This article is published in Disability and Health Journal.The article was published on 2015-01-01 and is currently open access. It has received 17 citations till now. The article focuses on the topics: Medicaid managed care & Medicaid.
Citations
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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.
15 citations
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.
12 citations
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.
11 citations
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.
8 citations
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TL;DR: It is found that ACO have so far devoted little attention to surgical care, and some ACOs have the ability to affect surgical practice patterns through referral pressures, but local market conditions may limit ACOs' abilities to alter surgeons' behavior.
Abstract: The Affordable Care Act supports the growth of accountable care organizations (ACOs) as a potentially powerful model for health care delivery and payment. The model focuses on primary care. However...
90 citations
TL;DR: Improved understanding of why family members are satisfied or dissatisfied with particular elements of the intensive care unit is provided and this knowledge can be used to modify intensive care units to better meet the physical and emotional needs of the families ofintensive care unit patients.
Abstract: Objectives:To describe the qualitative findings from a family satisfaction survey to identify and describe the themes that characterize family members' intensive care unit experiences.Design:As part of a larger mixed-methods study to determine the relationship between organizational culture and fami
83 citations
TL;DR: Findings indicated participants with any level of paid employment had significantly lower rates of smoking and better quality of life; self-reported health status was significantly higher, while per person per month Medicaid expenditures were less.
51 citations
TL;DR: States should not expect a dramatic change in health care access when they implement Medicaid MCOs to deliver care to the adult disabled population, however, continued attention to specialty care access is warranted for mandatory MCO enrollees.
Abstract: After more than a decade of experimentation with Medicaid managed care (MMC) for adults with disabilities (AWD), there is little evidence about how this policy change influences beneficiaries' access to health care (Ireys, Thornton, and McKay 2002). Yet the health and quality of life of persons with disabilities is particularly sensitive to the accessibility of their health care (Iezzoni 2002; Lawthers et al. 2003; U.S. Department of Health and Human Services 2005; Iezzoni and O'Day 2006;). While the relative effects of MMC on care access for nondisabled adults have been well studied (Zuckerman, Brennan, and Yemane 2002; Garrett, Davidoff, and Yemane 2003; Garrett and Zuckerman 2005; Kaestner, Dubay, and Kenney 2005; Le Cook 2007;), scholars caution against generalizing from such research to a population with a substantially different health profile (Rowland et al. 1995; Sisk et al. 1996; Currie and Fahr 2005;). Recognizing this gap between research and practice, Medicaid programs and the research community are building an evidence base to inform decisions about how best to care for this population (Landon et al. 2004; California Department of Health Services 2005; Volpel, O'Brien, and Weiner 2005; Center for Health Care Strategies Inc. 2006;).
This study contributes to that effort by assessing health care access and preventive care use for AWDs in Medicaid managed care organizations (MCOs) relative to fee-for-service (FFS). I apply two evaluation strategies to a nationally representative sample in an effort to reconcile the extant population-specific findings (Lo Sasso and Freund 2000; Coughlin, Long, and Graves 2009;). First, I assess the effect of being enrolled in an MCO relative to FFS, an evaluation perspective that may be most relevant to beneficiaries, advocacy groups, and to the program staff who monitor health plan performance (Highsmith and Somers 2003). The second evaluation strategy adopts the state's perspective and assesses the effect of MCO implementation on the total eligible population, including beneficiaries who opt out of MCOs or choose FFS where it is an option. This perspective may be particularly relevant to policy makers within, and outside of, Medicaid programs because it captures the overall impact of this programmatic change, including any potential spillover effects (Currie and Fahr 2005).
36 citations
TL;DR: HSR addressing individuals with disabilities is essential to bolster evidence for critical federal and state policy and programmatic decisions and HSR experts can lead efforts to improve data, methods, and the overall science of disability-related HSR.
Abstract: When asking me to write this piece, the Medical Care editor observed that relatively few health services research (HSR) articles address individuals with disabilities despite their disproportionate health care costs, needs, and growing numbers. I agreed with alacrity, allowing myself a private smile. Many HSR investigators who study individuals with disabilities have discovered that we share the experience of frequent journal rejections. Disappointment about editorial decisions is endemic throughout academe; thus, our laments (whining?) are easily dismissed. Nonetheless, the reasons for these rejections raise important questions. Two dominant critiques involve data validity and definitions of disability. Less frequent but more perplexing, editors assert that their readers are uninterested in individuals with disabilities (3 journal editors have told me this). Becoming scholarly serious, this last rational—readers being uninterested in individuals with disabilities—is (choose your metaphor) “hiding your head in the sand,” given the implications for health care costs, delivery system workforce and design, and the well-being of millions of historically disadvantaged Americans of all ages. HSR addressing individuals with disabilities is essential to bolster evidence for critical federal and state policy and programmatic decisions. Simultaneously, HSR experts can lead efforts to improve data, methods, and the overall science of disability-related HSR.
16 citations