Report Finds Medicaid Beneficiaries Ill-Equipped to Enter Managed Care
As state and federal regulations move more of the roughly 31 million Americans in the Medicaid system into managed care plans, a new study funded by the New York City-based Commonwealth Fund reveals that officials often fail to provide
the information beneficiaries need to select an appropriate plan and navigate the managed care system.
The report, Educating Medicaid Beneficiaries About Managed Care: Approaches in 13 Cities, examines data from 13 American cities with sizable Medicaid populations: Chicago, Detroit, Houston, Los Angeles, Memphis, Miami, Newark, New York, Philadelphia, Phoenix, Portland, Seattle, and the District of Columbia.
According to the report, from 1991 to 1998 the percentage of the Medicaid population enrolled in managed care plans surged from 10 percent to 54 percent. While the enrollment process is an ideal time to explain the elements of managed care to beneficiaries, the report found that education
efforts were inconsistent and often left benificiaries in the dark about health plan quality and
the roster of participating doctors and hospitals.
The report also states that low education and literacy levels among beneficiaries combined with the complexity of the health care system present a daunting challenge for policymakers seeking to develop programs to teach beneficiaries to understand, use, and benefit from Medicaid managed care.
"Medicaid beneficiaries need to become informed consumers of health services, seeking preventive and primary care early rather than waiting until conditions require emergency care," said Karen Davis, president of the Commonwealth Fund. "They need to understand managed care, its rules, and how
to advocate effectively for needed care for themselves and family members."
In conclusion, the report's authors call for a continuing, comprehensive education strategy that outlines a series of clear, focused messages tailored to the needs of people enrolled in Medicaid managed care. None of the cities examined in the report has such a strategy in place.
To read the full report online, visit:
http://www.cmwf.org/programs/quality_kaplan_educat_fr_380.pdf
"Beneficiaries Poorly Informed About Medicaid Managed Care." Commonwealth
Fund Press Release 5/17/2000.
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