Heathcare access and satisfaction: Adults with disabilities on Medicaid managed care

As Medicaid Managed Care (MMC) expands across states for people with disabilities, it is important to examine enrollees' access to and satisfaction with healthcare services. This study uses results from a longitudinal survey of adults with disabilities for the year prior to and the year after transitioning from fee for service to MMC in several Midwest counties. The response rate for the longitudinal survey (self or informant) was over 70%. The 181 respondents included three groups: developmental disabilities (73), mental health (35) and physical disabilities (50), and unspecified (23). Preliminary analyses did not find any significant differences in the number of medical services, equipment needs or specialist services over time. Similarly, there was no significant change in the number of preventative care services received. However, satisfaction with healthcare did decrease significantly (p=0.021). This decrease was only significant for the physical disability group (p=0.02) when the groups were compared. Our analysis suggests that the source of the decrease in satisfaction can be attributed to decreased satisfaction with primary care physicians (p=0.002 overall; p=0.044 for the mental health group), decreased satisfaction with medical services (p=0.001 overall; p=0.002 for the physical disability group), decrease in how easy it is to get an appointment with a specialist (p=0.005 overall; 0.024 for the physical disability group) and increased travel time to specialists (p=0.018 overall; p=0.022 for the developmental disability group). Qualitative data from the survey indicates problems finding doctors; difficulties obtaining dental services; and confusion about MMC, especially regarding billing.