“Advancing Knowledge. Improving Life.” Impact of Ohio Medicaid Eric Seiber, PhD Ohio State University.
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“Advancing Knowledge. Improving Life.”
Impact of Ohio Medicaid
Eric Seiber, PhD Ohio State University
“Advancing Knowledge. Improving Life.”
Medicaid Changes
• Many changes in Ohio Medicaid since 2004 Ohio Family Health Survey
• Changes include:– Eligibility changes for parents, foster youth,
and disabled children– New federal documentation rules for eligibility– Expansion of Medicaid managed care
“Advancing Knowledge. Improving Life.”
Effect of Changes
• What is the net effect of these changes?• early 2004 to late 2008
• Examining Medicaid beneficiaries:1. Access
2. Utilization
• Comparing Medicaid for entire year to:1. Private coverage for the entire year
(ESI, Privately purchased)
2. Uninsured and Part year coverage
• Statewide and by Region
“Advancing Knowledge. Improving Life.”
Children Groups
• Children – Ages 0 – 17
• Medicaid coverage entire year– All Medicaid Children– Medicaid Managed Care Markets
• In 2004, Mandatory counties, Preferred, None/Vol• By 2008, all counties were mandatory participation
• Private coverage entire year
• Uninsured and Part year coverage
“Advancing Knowledge. Improving Life.”
Adult Groups
• Adults – Ages 18 – 64
• Medicaid coverage entire year– All Medicaid adults– Healthy Start/Healthy Families– Aged, Blind, Disabled (ABD)– Undetermined Medicaid
• Private coverage entire year
• Uninsured and Part year coverage
“Advancing Knowledge. Improving Life.”
Indicators
• Access1. Usual source of sick care2. Rates care as High Quality3. Harder to obtain care last
three years4. Not obtaining medical care5. Problems seeing specialist6. Not obtaining dental care7. Delayed treatment for cost8. Major medical cost last 12
months9. Not obtaining needed drugs
• Utilization1. Well Child Visit last 12 mo2. Doctor visit last 12 mo3. Never a doctor visit4. Dentist visit last 12 mo5. Never a dentist visit6. Never received eye care7. Hospital stay last 12 mo8. ER visit last 12 mo
“Advancing Knowledge. Improving Life.”
Key Findings - Children
Not Obtaining Needed Medical Care, 2004 and 2008
“Advancing Knowledge. Improving Life.”
Key Findings - Children
Any Problem Seeing Specialist, 2004 and 2008
“Advancing Knowledge. Improving Life.”
Key Findings - Children
Delayed Treatment due to Cost, 2004 and 2008
“Advancing Knowledge. Improving Life.”
Key Findings - Children
Any Emergency Room Visit last 12 months, 2004 and 2008
“Advancing Knowledge. Improving Life.”
Key Findings - Children
Overnight Hospital Stay Last 12 months, 2004 and 2008
“Advancing Knowledge. Improving Life.”
Key Findings - Children
Any Emergency Room Visit last 12 months, 2004 and 2008
0
5
10
15
20
25
30
35
40
Mandatory Mgd Care Preferred Mgd Care No/Vol Mgd Care
2004
2008
“Advancing Knowledge. Improving Life.”
Key Findings - Children
Rates their Health Care as High Quality, 2004 and 2008
“Advancing Knowledge. Improving Life.”
Key Findings - Children
• Compared to the privately insured, Medicaid children report:
1. Equivalent access to outpatient services
2. Equivalent self-assessed quality of care
3. Equivalent or fewer problems seeing specialists
4. Less likely to identify cost as a barrier to care
“Advancing Knowledge. Improving Life.”
Key Findings - Children
• Medicaid Children from 2004 to 2008:
1. Inpatient and ER utilization declined
2. Largest utilization changes in counties transitioning to managed care
3. The reductions in utilization came with lower perceived quality of care
“Advancing Knowledge. Improving Life.”
Key Findings - Adults
Not Obtaining Needed Medical Care, 2004 and 2008
0
5
10
15
20
25
30
35
40
HS/HF Medicaid PrivateInsurance
ABD Medicaid Uninsured/ Partyear Coverage
2004
2008
“Advancing Knowledge. Improving Life.”
Key Findings - Adults
Any Problem Seeing a Specialist, 2004 and 2008
0
10
20
30
40
50
60
HS/HF Medicaid PrivateInsurance
ABD Medicaid Uninsured/ Partyear Coverage
2004
2008
“Advancing Knowledge. Improving Life.”
Key Findings - Adults
Delayed Treatment due to Cost, 2004 and 2008
0
10
20
30
40
50
60
HS/HF Medicaid PrivateInsurance
ABD Medicaid Uninsured/ Partyear Coverage
2004
2008
“Advancing Knowledge. Improving Life.”
Key Findings - Adults
Any Emergency Room Visit last 12 months, 2004 and 2008
0
10
20
30
40
50
60
HS/HF Medicaid PrivateInsurance
ABD Medicaid Uninsured/ Partyear Coverage
2004
2008
“Advancing Knowledge. Improving Life.”
Key Findings - Adults
• Compared to privately insured adults, Medicaid adults report:– More problems entering the health care system– Fewer cost barriers once in the system
• The ABD population reported higher utilization yet lower access than Healthy Start/Healthy Families enrollees
“Advancing Knowledge. Improving Life.”
Conclusions
• Access and Utilization– For low income children, Medicaid produces
results similar to the privately insured– Results were mixed for Medicaid adults,
especially ABD adults
• Costs– Complete picture will contrast changes in
access and utilization with changes in total costs per beneficiary
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