Two Common Barriers in Medicaid--and How to Overcome Them

HealthLeaders Media Staff, December 2, 2009

Federal lawmakers will likely expand Medicaid enrollment as a way to get some of the estimated 46 million uninsured health insurance coverage.

This is great news for health insurers that already serve Medicaid customers, such as members of the Association of Community Affiliated Plans—a group made up of 45 nonprofit safety-net plans that serve 7 million enrollees.

Insurers that don't have experience in Medicaid are also showing interest in getting involved in the Medicaid managed care world.

They understand Medicaid is a new growth area—along with the individual market, which has grown because of the lousy economic situation that has driven employers to cut health benefits and lay off employees.

There are some concerns for those without Medicaid experience though. Working with the Medicaid population means they need to make special accommodations and consider the barriers those beneficiaries face. The Medicaid population is quite different from those in employer-based plans—and insurers can't expect to offer the same services and plans as those in the traditional employer market.

Here are two common barriers to the Medicaid population getting proper healthcare and how Medicaid managed care insurers are handling the issues.

Housing, income, and transportation issues

Before even starting to deal with a member's health, a Medicaid health plan has to understand the barriers that can impede health.

One barrier is that the Medicaid population's housing situation isn't as predictable as those in employer-based insurance. Low-economic status forces many Medicaid beneficiaries to find new housing and often times they don't leave a forwarding address. Plus, there is no employer involved to help the insurer find the individual.

Tom Kelly, president and CEO of Schaller Anderson, an Aetna-owned Medicaid program serving 11 states, says the company's average Medicaid beneficiary resides in at least two places each year.

"Getting them into the system and getting them to report changes of address can be a difficult thing," says Kelly.

Two ways to deal with this problem is communicate with the new members from the start so the health plan is front of mind; and reach out to providers and community health centers, which often know their patients better than health plans.

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