This cross-cultural grounded theory investigation examined the ways 21 English-speaking white and Hispanic women in Medicaid managed care plans accessed prenatal and infant care. Theoretical sampling was a t the grassroots level, in the community at large, away from medical provider settings. Audio-taped data were collected in face-to-face, semi-structured interviews involving cultural interpretation. The women used a two-phase process to “gain entry” to the system of publicly sponsored insurance and health care (Phase I), and to “engage” those designated to help them (Phase II). The women’s process of accessing services involved navigating complex public and private systems, and paying both non-financial and financial costs to meet the goal of getting help with insurance and health care. Perceived intensity of need, stigma, personal power, system rules, and logistics shaped the women’s strategies for gaining entry into the system of care. Providers’/helpers’ approachability, competence, and propensity for advocacy shaped the women’s strategies for engaging helpers within the system. Related policy recommendations include maintaining women’s options to choose providers in public and private settings, discouraging provider lock-in periods, and covering all recommended medicines. Practice recommendations include developing service teams with specialized knowledge of poverty and addressing hidden costs of care. Structural, rather than individual, conditions primarily influenced the women’s use of Medicaid managed care.
Learning Objectives: After attending this presentation, the learner will: 1. identify at least four conditions affecting women's and infants access to Medicaid managed care; 2. describe at least two recommendations for Medicaid mamged care policy that facilitate access for these women.
Keywords: Access, Medicaid Managed Care
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.