Medicaid Beneficiaries Satisfied with Coverage and Access

July 13, 2017 - A recent Harvard Chan School of Public Health analysis found that Medicaid beneficiaries are overwhelmingly satisfied with their coverage and access to providers.  The nationwide survey of more than 60,000 beneficiaries also evaluated enrollees experiences with any barriers to receiving healthcare as a Medicaid member. 

“The debate on the future of Medicaid has largely marginalized a crucial voice: the perspective of enrollees. Our findings confirm that Medicaid programs are fulfilling their mission to provide access to necessary medical care,” said Michael Barnett, assistant professor of health policy and management at Harvard Chan School. 

The researchers evaluated data from the first National Medicaid Consumer Assessment of Health Providers and System (CAHPS) survey, fielded from December 2014 to July of 2015. The study was administered by CMS, and was designed to assess people’s experience with Medicaid services in 46 states.

The team used data from beneficiaries enrolled in Medicaid as of 2013. 

Notably, the survey included states that were not part of the 2014 Affordable Care Act (ACA) Medicaid expansion.   Thirty-one states have opted in to that expansion, which has brought an additional 14 million people into the program. Medicaid is currently the nation’s largest health insurer with over 70 million people receiving healthcare coverage through the program.

READ MORE: Medicaid Enrollment a “Lifeline” for Rural Residents, Children

Critics of Medicaid have often cited that the program does not provide members with access to adequate or quality healthcare, and was even harmful to its enrollees.  In a 2013 pre-ACA expansion survey of state’s governors, many opposed to the ACA expansion describe Medicaid as a “‘broken system’ that harms its beneficiaries.”

Further criticism has come from HHS Secretary Tom Price who told Congress in March 2017, that Medicaid, “decreased people’s ability to access care.”

The CMS survey sampled four groups of adult Medicaid enrollees: people with disabilities, dual eligibles (individuals enrolled in Medicaid and Medicare), those in managed care, and nondisabled people in fee-for-service medical care.  

Across the nation, the survey found that satisfaction was high among all beneficiaries, regardless of demographic or state ACA expansion status.

When asked about their opinion on the overall quality of Medicaid healthcare services, respondents used a scale from zero to ten, with zero being the “the worst health care possible” and 10 being “the best healthcare possible.”   Participating Medicaid beneficiaries gave the program an average rating of 7.9 out of ten.

READ MORE: Medicaid Service Equals or Surpasses Private Health Payers

Digging deeper into the overall Medicaid quality ratings, 46 percent of enrollees gave their Medicaid coverage a score of nine or ten, with only 7.6 percent of respondents rating their Medicaid coverage as a five or below. 

Medicaid satisfaction scores were more or less comparable to opinions from consumers of commercial insurance.  Private insurers received a mean satisfaction score of 8.6.

Medicaid beneficiaries also expressed satisfaction with their ability to access necessary care.  Eighty-four percent of enrollees said they had been able to access all the desired or prescribed care they needed in the past six months.  The satisfaction rate for beneficiaries was slightly higher in expansion states at 85.2 percent, versus non-expansion states at 81.5 percent.   

In contrast, only three percent of Medicaid members reported they were not able to access care due to either long waiting times or provider denial of their Medicaid coverage. 

Eighty-three percent of beneficiaries also reported having a usual source of care. Only two percent of enrollees reported they lacked a regular healthcare source for the stated reason that “no doctors take my insurance.”

READ MORE: Medicaid Expansion Boosts Coverage, Quality at Health Centers

The results build upon an earlier study from Harvard, which found that states participating in Medicaid expansion improved their rates of access to healthcare services.  These improvements were most measurable in two traditionally vulnerable populations: low-income adults and those with chronic conditions. 

“Our four years of data indicate that the ACA’s coverage expansion to low-income adults was associated with significant improvements in access to primary care and medications, affordability of care, preventive visits, screening tests, and self-reported health,” the Harvard study reported.

The earlier study compared data from low income adults in Arkansas and Kentucky,  which both had uninsured rates of over 40 percent prior to the ACA Medicaid expansion.

In addition to seeing a 20 percent decrease in their uninsured rates, both states also witnessed  a 29 percent increase in the number of residents with a personal doctor, and a 24 percent increase in the number who have attended an annual primary care visit in the past calendar year. 

Research also showed a 41 percent increase in previously uninsured residents who now have a regular source of healthcare.  

The costs of care also decreased, the researchers found.  The study found an average out-of-pocket spending reduction of $337 per year.  As a result, 25 percent fewer patients reported having trouble paying their medical bills.

Overall, residents of Arkansas and Kentucky were now also 42 percent more likely to report they’re in “excellent” health.   

“In summary, we found that Medicaid enrollees are largely satisfied with their care, and that few perceive their insurance as a major barrier to care. Changes to Medicaid that would result in millions of beneficiaries losing coverage could have major adverse effects,” concluded the report.