Medicaid expansion, managed care plan composition, and enrollee experience

Area of Science:

• Health Services Research
• Public Health Policy
• Healthcare Management

Background:

• Medicaid expansion under the Affordable Care Act aimed to increase insurance coverage.
• Managed care organizations (MCOs) are key providers within the Medicaid program.
• Understanding changes in MCO enrollee composition and experience is crucial for evaluating policy impact.

Purpose of the Study:

• To analyze shifts in the demographic composition of enrollees within Medicaid Managed Care Organizations (MCOs).
• To assess changes in the healthcare access and experience of MCO enrollees following state Medicaid expansion.
• To identify potential impacts on care access metrics for vulnerable populations.

Main Methods:

• Utilized data from the Adult Medicaid Consumer Assessment of Healthcare Providers and Systems surveys (2012-2018).
• Employed multivariable linear probability models to compare pre- and post-Medicaid expansion periods.
• Conducted an event-study regression analysis to model changes over time in expansion versus non-expansion states.

Main Results:

• Medicaid expansion correlated with a decrease in female enrollees and an increase in older (55-64 years) and non-Hispanic White enrollees.
• In the first year post-expansion, MCO enrollees in expansion states reported less access to a personal doctor and timely specialty care.
• These negative impacts on access were not statistically significant by the second year after expansion.

Conclusions:

• Medicaid expansion significantly altered the demographic profile of MCO enrollees.
• Policy makers should consider these demographic shifts when evaluating MCO performance metrics.
• Strategies may be needed to ensure continued access to care amidst changing enrollee populations.