About 1 in 5 Americans is covered by Medicaid, making it the single largest insurance program in the US.
Medicaid is a critical safety net program for low-income individuals, many of whom have chronic mental and physical health conditions. The majority of state Medicaid programs now contract with managed care organizations to provide Medicaid services. Use of managed care has the potential to improve outcomes for enrollees by providing assistance in navigating the health care system and in managing chronic conditions.
However, in order to control costs, managed care organizations sometimes also have policies that can limit to access to care.
Read the report on KanCare:
Our recent study sought to understand the experiences of Kansans with serious mental illness enrolled in KanCare, the state’s Medicaid managed care program. In particular, our study explored enrollees’ overall satisfaction with KanCare, areas of unmet need, and their suggestions for improving the program.
Our sample of participants was drawn from individuals living in 1 of 10 different Kansas counties in rural and urban parts of the state. Overall, more than half of participants reported being in fair or poor heath (compared to 15 percent of the state’s general population) and 73 percent reported having one or more chronic physical health conditions in addition to their mental health condition(s).
In general, participants were happy to have KanCare coverage for their mental and physical health care services and thought that out-of-pocket costs were reasonable. They were particularly appreciative of having prescription coverage and experienced some peace of mind knowing that they would be protected against catastrophic medical costs. At the same time, however, participants noted many unmet needs and barriers to care:
- Difficulty accessing consistent information about their coverage, which made it difficult to find doctors and get care;
- Difficulty accessing specific needed medications due to coverage limitations or out-of-pocket costs, which sometimes resulted in people being unable to take needed medications;
- Lack of coverage for dental services other than cleanings — many noted that medications cause them to have a dry mouth, which can lead to cavities and other oral health problems;
- Problems with using Medicaid-funded, non-emergency medical transportation services, such as a requirement to schedule rides three days in advance, which led to missed medical appointments;
- Difficulty obtaining medical equipment or devices such as CPAP machines or diabetic shoes, which could result in worsening medical problems in the long term;
- Limited provider networks, especially for specialists — some reported being unable to see specialists recommended by their primary care providers; and
- Difficulty obtaining or maintaining eligibility for KanCare due to application backlogs, which can lead to coverage gaps and lack of care.
In addition, fewer than 1 in 5 participants reported having worked with a care coordinator from their managed care organization. As noted above, one potential benefit of managed care is having assistance navigating medical services and managing chronic conditions. This is particularly true for a population with mental illness or multiple chronic conditions and, often, difficulty with processing information.
Participants encouraged the state of Kansas to address these identified unmet needs and barriers to care. As the state begins the process to accept bids for new managed care contracts, we hope that some of these findings can be used to strengthen the KanCare program not only for enrollees with mental illness, but for all Kansans.