Jean P Hall1, Noelle K Kurth2, Shawna L C Chapman3, Theresa I Shireman4. 1. Institute for Health and Disability Policy Studies, University of Kansas, 1122 West Campus Rd., Room 517, Lawrence, KS 66045, USA; Department of Health Policy and Management, University of Kansas Medical Center, 3901 Rainbow Boulevard, Mailstop 3044, 5001 Student Center, Kansas City, KS 66160, USA. Electronic address: jhall@ku.edu. 2. Institute for Health and Disability Policy Studies, University of Kansas, 1122 West Campus Rd., Room 517, Lawrence, KS 66045, USA. 3. Duke University School of Medicine Department of Psychiatry and Behavioral Sciences, Box 3903, Durham, NC 27710, USA. 4. Department of Preventive Medicine and Public Health, University of Kansas Medical Center, 3901 Rainbow Blvd, Mailstop 1008, 4030 Robinson, Kansas City, KS 66160, USA.
Abstract
BACKGROUND: States are increasingly turning to managed care arrangements to control costs in their Medicaid programs. Historically, such arrangements have excluded people with disabilities who use long-term services and supports (LTSS) due to their complex needs. Now, however, some states are also moving this population to managed care. Little is known about the experiences of people with disabilities during and after this transition. OBJECTIVE: To document experiences of Medicaid enrollees with disabilities using long-term services and supports during transition to Medicaid managed care in Kansas. METHODS: During the spring of 2013, 105 Kansans with disabilities using Medicaid long-term services and supports (LTSS) were surveyed via telephone or in-person as they transitioned to managed care. Qualitative data analysis of survey responses was conducted to learn more about the issues encountered by people with disabilities under Medicaid managed care. RESULTS: Respondents encountered numerous disability-related difficulties, particularly with transportation, durable medical equipment, care coordination, communication, increased out of pocket costs, and access to care. CONCLUSIONS: As more states move people with disabilities to Medicaid managed care, it is critically important to address these identified issues for a population that often experiences substantial health disparities and a smaller margin of health. It is hoped that the early experiences reported here can inform policy-makers in other states as they contemplate and design similar programs.
BACKGROUND: States are increasingly turning to managed care arrangements to control costs in their Medicaid programs. Historically, such arrangements have excluded people with disabilities who use long-term services and supports (LTSS) due to their complex needs. Now, however, some states are also moving this population to managed care. Little is known about the experiences of people with disabilities during and after this transition. OBJECTIVE: To document experiences of Medicaid enrollees with disabilities using long-term services and supports during transition to Medicaid managed care in Kansas. METHODS: During the spring of 2013, 105 Kansans with disabilities using Medicaid long-term services and supports (LTSS) were surveyed via telephone or in-person as they transitioned to managed care. Qualitative data analysis of survey responses was conducted to learn more about the issues encountered by people with disabilities under Medicaid managed care. RESULTS: Respondents encountered numerous disability-related difficulties, particularly with transportation, durable medical equipment, care coordination, communication, increased out of pocket costs, and access to care. CONCLUSIONS: As more states move people with disabilities to Medicaid managed care, it is critically important to address these identified issues for a population that often experiences substantial health disparities and a smaller margin of health. It is hoped that the early experiences reported here can inform policy-makers in other states as they contemplate and design similar programs.