MEDICAID: ‘Unfair, Personal’ Questions Thwart Enrollment
Researchers at George Washington University report that the "real stigma" in the Medicaid program is how people feel they will be treated during the application process and in physician's offices, according to Reuters Health. In the study, "Beyond Stigma: What Barriers Actually Affect the Decisions of Low-Income Families to Enroll in Medicaid," the researchers conducted interviews with 1,400 low-income families and found that more than one-third said they don't enroll in Medicaid because they believe they will have to answer "unfair, personal questions" during the application process. Among families who had applied for Medicaid in the last two years, 55% were asked during the application process "how they handle money," 48% were asked about alcohol and drug use, 16% were asked about their sex life and 77% were questioned about "the paternity of their children." Researchers found that those who associated Medicaid enrollment with "embarrassing" questioning were more than twice as likely to be eligible for benefits but not enrolled than those who did not express concerns about application questioning. In addition, respondents who stated that they believed doctors treated Medicaid patients differently from privately insured patients were 1.7 times more likely to be eligible but not enrolled. Respondents also indicated that they associated more stigma with applying for Medicaid in a welfare office than applying in another venue, such as a hospital or health clinic. Sixty-nine percent of survey participants who applied for Medicaid in a welfare office "did not feel respected," compared to 42% of respondents who applied elsewhere. Respondents also cited the following as other barriers to Medicaid enrollment: the length and complexity of the application; confusion over eligibility; and the false belief that in order to receive Medicaid, a person must receive welfare.
Eliminating the Barriers
To overcome enrollment barriers, lead researcher Jennifer Stuber and her colleagues recommended that state Medicaid agency officials simplify application forms, removing any questions that are "irrelevant to Medicaid eligibility." In addition, the authors suggested that the Medicaid application process move out of the welfare office and into health clinics, hospitals, schools and child care centers. Daniel Hawkins, vice president of federal and state affairs at the National Association of Community Health Centers, said, "It is very clear from the results of this study that families don't want to deal with a government to get health care coverage. That's the beauty of placing Medicaid application assistant at health centers -- patients get the assistance they need, where they need it -- without feeling like they are begging a bureaucrat for a handout" (7/31). The report, which was sponsored by the Robert Wood Johnson Foundation, is published in the July 2000 Issue Brief of the George Washington University Center for Health Services Research and Policy, and is available by typing http://www.hfni.gsehd.gwu.edu/~chsrp/ into your Web browser.