Citation URL: http://www.urban.org/MatthewSchirmer

Medicaid-eligible uninsured children were healthier than Medicaid enrollees, but were 17 percent more likely to lack a usual source of care, 12 percent more likely to report unmet need, and 16 percent more likely to report high out-of-pocket medical spending. Medicaid-eligible children with private insurance were more likely to have a usual source of care, but were also more likely to report delays in seeking care and face higher out-of-pocket spending. Based on the 1994 and 1995 NHIS, the researchers adjust for demographic, socioeconomic and health characteristics to measure the impact of Medicaid coverage. Results suggest that Medicaid enrollment gains will yield important improvements in access to care.

Among Medicaid-eligible children in the U.S., an estimated 17 % are uninsured, with 27% covered by private insurance. Uninsured children have become a target for state outreach and enrollment efforts. However, the effort may not be a worthwhile use of resources if these children have sufficient access to primary care and are able to enroll in Medicaid should serious health problems arise. This analysis of data from the National Health Interview Survey from 1994 and 1995 suggests otherwise. Although the uninsured Medicaid-eligible children are healthier than their enrolled counterparts, they face reduced access to care and lower rates of service use. After controlling for health status and other characteristics, we find that being uninsured increases the likelihood of being without a usual source of care, and increases unmet need. Being uninsured decreases the proportion of children with any health provider visits, and increases the proportion with family out-of-pocket expenses exceeding $500. These findings lend support to the hypothesis that the enrollment process is onerous for some families. Targeted efforts to enroll the uninsured Medicaid eligible children could help in reducing the effect of barriers and reducing differences in access to care. (Inquiry 2000 Summer; 37: 203-218).

This paper reports on a new survey of state Medicaid managed care payment rates. We collected rate data for Medicaid’s Aid to Families with Dependent Children (AFDC)/Temporary Assistance for Needy Families (TANF) and poverty-related populations and made adjustments to make the data comparable across states. The results show a slightly more than twofold variation in capitation rates among states, caused primarily by fee-for-service spending levels and demographics. There is a very low correlation between the variation in Medicaid rates among states and the variations in Medicare’s adjusted average per capita cost. The data are not sufficient to answer questions about the adequacy of rates but should help to further policy discussions and research. (Health Affairs 1999 May/June; 18(3): 217-227).

The first nationwide comparison of how much states are paying for Medicaid managed care shows more than a two-fold variation in the rates set by 36 states. Of the 36 states responding to the survey, the highest managed care capitation rates occur in Connecticut, Hawaii, Kentucky, Massachusetts, New Hampshire, New Mexico, Texas, Utah, and the District of Columbia; the lowest rates occur in California, Florida, Georgia, Indiana, Kansas, Nevada, South Carolina, Tennessee, and Wisconsin. Capitation rates refer to the amount per Medicaid enrollee that the state pays to the managed care plan per month. The survey found several reasons why rates vary.

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