WOMEN’S HEALTH: Medicaid Managed Care Poses Barriers

      The Center for Women's Policy Studies released a report Friday showing that Medicaid managed care plans create barriers to care, especially for women with chronic illnesses. According to the group, this is the first-ever study of how well managed care is servicing the needs of low-income women. The Center reviewed Medicaid managed care contracts in 10 states and the District of Columbia and conducted an in-depth analysis of the New Jersey contract. The report found that the integration of managed care and Medicaid services simply does not occur. "The overall management ... of a full complement of health services for low-income women may ... be undermined by the managed care plans," the report states. The study found that managed care increases the fragmentation of low-income women's health care by forcing enrollees to go outside the plan for many critical Medicaid-covered services, such as family planning, substance abuse treatment and STD/HIV treatment. Further, the study noted that many enrollees "do not even know that providers serving people with Medicaid exist outside the plan." According to the study, three major weaknesses exist in Medicaid managed care plans: a failure to provide a comprehensive package of Medicaid-covered health services or to provide formal referrals for services outside the plan; an absence of systems for consumer accountability, including impartial advocates to help patients pursue grievances and a failure to guarantee freedom of provider-patient communications and to protect the confidentiality of medical records. The report also includes a set of more than 100 consumer protections and safeguards recommended for Medicaid managed care plans.

The Bigger Picture
      The group noted that its report, "Managed Care: Serving the Needs of Women?," was issued the same day that President Clinton announced plans to implement a consumer bill of rights for people employed or insured by federal health programs. Center President Leslie Wolfe said, "President Clinton's consumer protections are an important step, but even more is needed to protect the health of low-income women. ... The experiences of women should inform policy debates about consumer safeguards for public and private managed care plans. ... Our report should remind state legislators and Members of Congress of the peril of neglecting the needs of women when mandating consumer protections for managed care." For more information on the study, contact the Center at 202/872-1770 (release, 2/23).