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Researchers examine access to care and quality for Medicaid MCO enrollees who have disabilities

Many disabled Supplemental Security Income (SSI) recipients are enrolled in Medicaid managed care plans. Their disabilities, ranging from mental retardation and paralysis to severe diabetes and blindness, may challenge managed care organizations (MCOs). These vulnerable individuals often need ongoing specialist care, and they may require extensive social supports and coordination.

The access to care provided to Medicaid managed care enrollees with disabilities and the quality of care they receive seem to depend on network size, financial incentives, how tightly their health care use is managed, and State requirements, according to a study by Steven C. Hill, Ph.D., of the Agency for Healthcare Research and Quality, and Judith Wooldridge, M.A., of Mathematica Policy Research. Mathematica surveyed blind/disabled SSI enrollees in four MCOs serving TennCare, Tennessee's Medicaid managed care program, from 1998 through spring 1999. The researchers compared enrollee reports of access to care and quality across the four MCOs, controlling for enrollee characteristics.

Although the four MCOs' characteristics varied, access to providers, coordination of care, and access to some services were generally similar across MCOs. None of the MCOs provided much care coordination. Instead, most often a family member or friend coordinated care.

The plans reported using similar utilization review methods, but access to specialists and delays in getting care differed for OmniCare and Blue Care enrollees. OmniCare enrollees were most likely to report that they had to wait for the plan's approval before obtaining care (23 percent) and that their plan failed to refer them to a specialist when they needed one (10 percent). Blue Care enrollees were the least likely to report delays in receiving approval of care, and they gave higher ratings for access to specialists. The researchers conclude that the differences in access to services among plans may be due to differences in how tightly utilization was reviewed, rather than to characteristics reported by the plans.

See "Plan characteristics and SSI enrollees' access to and quality of care in four TennCare MCOs," by Dr. Hill and Ms. Wooldridge, in the October 2002 Health Services Research 37(5), pp. 1197-1220.

Reprints (AHRQ Publication No. 03-R012) are available from the AHRQ Publications Clearinghouse.

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