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Health Care Costs and Financing

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Researchers examine access to care and satisfaction among SSI enrollees in Tennessee's Medicaid program

Supplemental Security Income (SSI) recipients are poor people who are too disabled to work. These individuals, whose disabilities range from blindness and severe asthma to mental retardation and cerebral palsy, often need long-term specialist care or require extensive social supports and care coordination to address chronic limitations in functioning. SSI recipients are enrolling in Medicaid managed care. Their health care needs are extensive, diverse, and complex, and those needs may represent a challenge to managed care organizations in programs like TennCare, Tennessee's Medicaid managed care program.

According to a recent study, SSI recipients enrolled in TennCare have similar or slightly worse access to care than other TennCare enrollees. A significant minority of SSI enrollees report unmet needs for care, such as not getting referrals to specialists, prescription drugs, and special medical equipment. The study was conducted by Steven C. Hill, Ph.D., of the Agency for Healthcare Research and Quality's Center for Cost and Financing Studies, and Judith Wooldridge, M.A., of Mathematica Policy Research, Inc.

Mathematica conducted computer-assisted telephone surveys of urban SSI and other urban TennCare enrollees to assess their access to care, care coordination, and satisfaction. Results revealed that SSI enrollees had mixed experiences, and they faced problems in areas particularly important to people with disabilities. For example, compared with other TennCare enrollees, SSI adults had longer travel times to providers, and fewer SSI children could get an appointment within 1 week. Adult SSI enrollees rated their managed care organization lower than other enrollees, and all SSI enrollees were less satisfied with provider communication, such as explanation of medical procedures.

Nearly one in five SSI enrollees had to wait for their plan to approve care, most often for specialist or other physician care or for prescription drugs. About 6 percent of SSI adults and 4 percent of parents of SSI children said their plan failed to refer them to a specialist or therapist, and the consequences for those affected were often serious. About one in five SSI adults had unmet needs for physician care, and 17 percent had unmet needs for prescription drugs. Six percent had unmet needs for special medical equipment, mostly wheelchairs, other mobility aids, respiratory aids, and neck, back, and knee braces. About 10 percent of adult SSI enrollees and 12 percent of children did not have someone to arrange or coordinate medical care, mental health care, personal care, or social services.

See "SSI enrollees' health care in TennCare," by Dr. Hill and Ms. Wooldridge, in the May 2003 Journal of Health Care for the Poor and Underserved 14(2), pp. 229-243.

Reprints (AHRQ Publication No. 03-R040) are available from the AHRQ Publications Clearinghouse.

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