State Policies And Enrollees' Experiences In Medicaid: Evidence From A New National Survey.

Abstract

Medicaid provides health insurance to more than seventy million Americans, yet there has been little systematic analysis of what factors influence enrollees' satisfaction with and access to care. Using a nationally representative survey of more than 270,000 Medicaid enrollees in 2014-15, we examined the consumer perspective on care in Medicaid. Average satisfaction ratings were 7.9 out of 10.0, but there were significant disparities across racial/ethnic groups. Satisfaction and access measures were generally similar among enrollees in managed care versus fee-for-service Medicaid. Access was significantly better in states where more physicians per capita accepted Medicaid patients: A one-standard-deviation increase in participating physicians per 100,000 population was associated with a 4.6-percentage-point increase in having a personal doctor. This was particularly true in fee-for-service Medicaid, and measures of physicians per capita were stronger predictors of patient experience than the simple percentage of doctors who accept Medicaid. Among those in Medicaid managed care, greater spending per enrollee was a significant predictor of satisfaction and access. Our findings emphasize that physician availability makes a difference in patients' experiences in Medicaid, and they indicate that racial/ethnic disparities in those experiences persist even among a uniformly insured population.