New Medicaid Enrollees Unsure How To Use Coverage, Study Finds
Millions of U.S. residents who gained Medicaid coverage through the Affordable Care Act's Medicaid expansion might not understand how to use their new coverage, according to focus group findings presented to the Medicaid and Children's Health Insurance Program Payment and Access Commission on Friday, Modern Healthcare reports.
PerryUndem Research/Communication conducted six focus groups with newly enrolled Medicaid beneficiaries in:
- Illinois; and
- Oregon (Dickson, Modern Healthcare, 9/19).
The groups included about 60 individuals total who were interviewed during June and July (Adams, CQ HealthBeat, 9/19).
According to the findings, some states did not provide new Medicaid beneficiaries with information on how to use their coverage, although some new enrollees were directed to websites or given informational pamphlets. PerryUndem Research/Communication Partner Michael Perry said "a big information gap" exists in which "people are newly enrolled, but they don't understand coverage limits."
For example, some new Medicaid beneficiaries do not receive dental coverage, which is a large reason why many sought coverage, according to Modern Healthcare (Modern Healthcare, 9/19).
Meanwhile, focus group participants reported that their most significant problem was locating a primary care physician. According to the research, some participants said they:
- Had to call at least six health care providers before locating a physician;
- Had to choose physicians who were located far from their homes;
- Suspected that some physicians were limiting the number of Medicaid beneficiaries they would see;
- Were not accustomed with the process of finding a PCP; and
- Did not try to locate a PCP because they did not think it was urgent to do so.
Other participants reported having difficulties finding specialists or dentists, while beneficiaries in Portland, Ore., said they had a hard time accessing mental health care services.
Other issues participants reported included:
- Fearing they would receive limited or low-quality care;
- Discovering unexpected dental coverage limits (Millman, "Wonkblog," Washington Post, 9/19); and
- Not knowing what their potential out-of-pocket costs could be.
Beneficiaries Unaware of Re-Enrollment Process
Meanwhile, the research group found that many new beneficiaries were unaware they need to re-enroll in coverage annually, even if their personal situations have not changed. Perry said that many states have not provided information on what to expect during the re-enrollment process, which could lead to some beneficiaries losing coverage.
To fix the issue, Perry said states should provide more information on the process, including what beneficiaries must do to ensure their coverage continues. In addition, the Association for Community Affiliated Plans is pushing Congress to pass legislation (S 1980, HR 1698) that would guarantee beneficiaries have 12 continuous months of coverage, despite any changes in an individual's circumstances (CQ HealthBeat, 9/19).
Overall, New Medicaid Enrollees Are Satisfied
Despite their confusion, focus groups participants said they mostly were satisfied with their coverage.
According to the research, new beneficiaries said before they were insured, they often delayed needed care or faced medical expenses for care they could not delay. Now, the beneficiaries said they feel more at ease knowing they have coverage and are less concerned about whether they can afford receiving health care.
Most of the beneficiaries said they already have used their benefits and reported feeling healthier. Further, all of the participants said that they would re-enroll in the coverage if they need to and that they have been encouraging friends and family members to enroll ("Wonkblog," Washington Post, 9/19).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.