Determining whether Medicaid managed care can meet the needs of people with disabilities is a policy question of growing urgency as more states enroll Supplemental Security Income (SSI) recipients in Medicaid managed care. SSI recipients are a vulnerable population with physical disabilities, mental illness, and mental retardation. In 1994, Tennessee implemented a Medicaid managed care program, called TennCare, which currently serves 1.3 million enrollees, including 122,000 blind/disabled SSI enrollees. All enrollees, including SSI recipients, are in capitated managed care organizations (MCOs) for medical/surgical services. We used computer-assisted telephone interviews to ask SSI enrollees about their care.
In some ways SSI enrollees had about the same experiences as other TennCare enrollees, but they also experienced some additional barriers to care and had lower satisfaction in some domains. Some SSI enrollees reported unmet needs for services important to people with disabilities, such as special medical equipment, and 5 percent reported their MCO failed to refer them for specialist care they thought they needed. Comparisons among MCOs suggest that people with disabilities may have better access to care and greater satisfaction in MCOs that manage care less tightly. Characteristics of these MCOs include, for example, using a broad network of providers and paying physicians primarily fee-for-service. But some types of interventions are good: enrollees may have better access to specialists in MCOs that undertake greater efforts to improve care for people with chronic conditions; they may have better access to care in MCOs that remind enrollees about appointments and provide transportation.
Learning Objectives: Participants in this session will learn (1) about the experiences of people with disabilities in a Medicaid managed care program, and (2) potential lessons for other managed care programs for people with disabilities
Keywords: Managed Care, Disability
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.