For many people who receive Medicaid, having health care coverage does not equate to getting health care services. In an effort to understand and bridge this gap, we went straight to the source: Medicaid recipients. This newly released, extensive report spanned the country and was not limited to our members.
Here are some key takeaways from the report:
There’s no such thing as a “typical” Medicaid recipient. Medicaid serves children, adults, seniors and people with disabilities of every race and every background in all states and territories. In fact, one in five Americans are covered by Medicaid at any given time, with nearly three in five Americans reporting in a 2017 Kaiser Foundation poll that Medicaid is important to them and their family.
Medicaid recipients feel stigmatized and labeled. They expressed concern that their access to high-quality care is limited. The majority do not have a relationship with a Primary Care Provider and many still see the ER as a go-to, “first resort” for getting care. Additionally, 20 percent say that they feel doctors and specialists don’t like Medicaid patients, which can lead to disengagement with the health care system.
Medicaid recipients must navigate a variety of programs, agencies and rules. Fragmented benefit design often means recipients must get behavioral health from one health plan, physical health services from another and long-term services and support (LTSS) from yet another. This leads to frustration, confusion and often “giving up” trying to find care. “I often feel buried and overwhelmed by trying to navigate the system to find the best help and resources for our daughter,” one survey participant said. “I know that there are a lot of resources but if you don’t know the right questions to ask then you will stay lost.”
Social determinants of health matter. Nearly 1 in 5 cite lack of transportation as a key barrier to getting medical care. And, only about 1 in 4 feel like they can access fresh, nutritious foods, which can have a direct effect on chronic diseases.
Health literacy can also be a huge concern. Health care can be hard to explain. And with 77 million American adults with basic or below basic health literacy, understanding health care is a widespread problem. But compared to commercial and Medicare populations, Medicaid consumers are the least likely to say they can explain a variety of health care terms. One member simply states, “I’ve been on Medicaid a long time and I don’t know anything about it. I’d like someone to teach me. Tell me. I’ve been trying to understand it.” Moreover, language barriers and a lack of cultural competency can also hinder understanding about health care. For example, according to the study, 68% of Hispanic adults have difficulty with health literacy, compared to just 28% of white adults.
How to move forward
There isn’t a one size fits all solution that’s easy to implement. Rather a variety of approaches should be developed that are informed by listening to the voices of the millions of Americans accessing Medicaid.
As one survey participant noted: "No one should have to choose [between] 'Should I pay my light bill or my medication.’"
For Further Reading:
Medicaid as Seen Through the Eyes of Beneficiaries (full white paper)