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1st
appeared 30 November 1998
Medicaid Managed Care May Compromise Care to
Low-Income Women and Children
Community clinics function in local health care systems as "safety net"
providers for low income people without private insurance. However, the implementation of
Medicaid managed care programs at state or local levels can compromise the role of
community clinics in providing culturally-competent health care to women and children,
according to a new study led by UCSF health policy researchers.
"We found a significant decline in use of maternal and child health services in
Sacramento County community clinics after the introduction of Medicaid managed care,"
said Carol Korenbrot, UCSF associate professor of health policy and the obstetrics,
gynecology and reproductive sciences. "For women and children who become uninsured,
this means it is more difficult to find clinics able to serve them."
Korenbrot and UCSF researchers presented their findings at a recent annual meeting of the
American Public Health Association in Washington DC.
The UCSF researchers studied the effects of Medicaid managed care on maternal child health
services of community clinics in California counties. California has been introducing
Medicaid managed care programs on a county-by-county basis since 1982, using three models
similar to models being used throughout the country: 1) a single government organized plan
(County Organized Health System, COHS); 2) a competitive dual-plan model with one
government-organized and one for-profit plan; and 3) a competitive plan with multiple for
profit and non-profit plans and no government organized plan (Geographic Managed Care or
GMC in California).
The UCSF researchers conducted a study of the GMC model which was implemented in
Sacramento county in 1994 to determine if the introduction of the GMC model of Medicaid
managed care decreased the number of service encounters for women and children at licensed
primary care community clinics in that county.
Korenbrot and her colleagues tested whether there was a difference between clinics in
similar counties where Medicaid managed care was not introduced and clinics in Sacramento
county.
Study findings show a significant reduction in women's and children's service encounters
at community clinics in Sacramento County after the implementation of GMC.
"Community clinics in Sacramento County experienced a significant decline (39
percent) in service encounters for women and children services compared to the small
decrease (4 percent) at clinics in comparable counties," said Korenbrot. "In
addition, there was a similar pattern for children's encounters, which declined
significantly by 64 percent compared to the increase (26 percent) in other counties.
The community clinics that women and children who are uninsured depend on for care have
lost badly needed Medi-Cal revenues, according to Korenbrot. Clinics that serve low
income, uninsured and Medi-Cal-eligible populations throughout the state have increased
their dependence on Medi-Cal revenues in recent years because of changes in federal and
state policies. When clinics in Sacramento experienced a decline in Medi-Cal client
encounters, they also lost Medi-Cal revenues. These revenues were essential to maintain
staffing and other essential features of the clinics, Korenbrot said. With reductions in
Medi-Cal paid clinic encounters, clinics are not as able to provide services to uninsured
women and children, she added.
In Sacramento County, state and local officials are taking action to integrate better the
clinics with commercial Medicaid managed care plans so their ability to serve the
uninsured is not further compromised. The community clinics themselves have formed a
county-wide clinic consortium to address their common concerns about providing care to the
county's vulnerable populations and how to cover the costs.
To prevent a decrease in use of maternal and child health services, health policy
researchers recommend integrating the clinics into provider organizations that contract
with managed care plans so that more Medicaid enrolled mothers and children can use the
clinics.
Full press release
UCSF Study Finds Support
Services Improve Birth Outcomes for Low-Income Women
Source: Lordelyn P. del
Rosario, News Services |
