142nd APHA Annual Meeting and Exposition

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Impact of Medicaid Managed Care on the Health Services Appraisal and Access of Adults with Disabilities

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Sunday, November 16, 2014

Tamar Heller, PhD , Department of Disability and Human Development, University of Illinois at Chicago, Chicago, IL
Randall Owen, PhD , Department of Disabiltiy and Human Development, University of Illinois at Chicago, Chicago, IL
Anne Bowers , Dept of Disability and Human Development, University of Illinois at Chicago, chicago, IL
Dale Mitchell, PhD , Department of Disabiltiy and Human Development, University of Illinois at Chicago, Chicago, IL
Yochai Eisenberg, MUPP , Department of Disability and Human Development, University of Illinois at Chicago, Chicago, IL
Kiyoshi Yamaki, Ph.D. , Department of Disability and Human Development, University of Illinois at Chicago, Chicago, IL
Background: This study examines the health care experiences and access of people with disabilities in Medicaid receiving managed care (MC) versus those in fee for services (FFS) health care over two years.

Methods:  The study uses survey data from 817 individuals (430 in MC; 387 in FFS) two years after the start of the MC initiative along with encounter data on health care utilization from the population of 39,653 in MC and 68,839 in FFS. The survey includes measures of health care appraisal, ease of receiving medication, and ease of using transportation. Health care utilization comprises emergency room (ER) use and days in the hospital.  Regression analyses with these outcomes included the Independent variables of age, gender, race, disability type, and enrollment in MC versus FFS.

Results:   Health care appraisal and ease of receiving medication did not differ between the MC and FFS groups. However, people with physical disabilities in MC reported a worse appraisal versus FFS, while people with a mental health disability in MC reported a better appraisal versus people in FFS (p<.05). Also, people with physical disabilities had better access to prescriptions in MC (p <.05).Transportation assistance was more positive (p <.01) for people in MC.  Both ER use and days in hospital decreased (-8% and -18%) for people in MC and increased for people in FFS (5%).

Conclusion: As MC approaches increase for Medicaid participants with disabilities it is important to assess the differential experiences of various disability groups within MC and in comparison to FFS.

Learning Areas:

Diversity and culture
Public health or related public policy

Learning Objectives:
Assess the impact of managed care versus fee-for-serice for people with disabilities with regard to health services appraisal and access

Keyword(s): Disabilities, Managed Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the principal investigator of a NIDRR RRTC on health and intellectual disability, as well as PI on two other research projects at two other RRTCs. I have 210 publications, 105 of them in refereed journals, about disability, health and policy
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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