Enrollee, Plan, and State Characteristics Associated With Experience of Care Among Adults in Medicaid Managed Care.

Abstract

Objective: To examine five enrollee-reported experience of care metrics and assess enrollee, plan, and state characteristics associated with higher care ratings.

Study setting and design: We conducted a repeated cross-sectional study using multivariable linear probability models and predictors that captured various enrollee, plan, and state characteristics. We evaluated five enrollee-reported experience of care measures: being "always or usually" easy to get needed care (yes/no), having a personal doctor (yes/no), having timely access to a checkup or routine care (yes/no), having timely access to specialty care (yes/no), and healthcare rating (0-10).

Data sources and analytic sample: We used enrollee-level data for adults aged 18-64 from the National Committee on Quality Assurance (NCQA) Adult Medicaid Managed Care Member Experience Survey in 2018 and 2020.

Principal findings: The study included 94,296 adults enrolled in 172 Medicaid managed care plans in 38 states and who responded to the member experience survey. Enrollees from racially and ethnically minoritized groups reported significantly worse experiences of care than non-Hispanic White enrollees on all outcomes. Larger plan size was associated with a lower likelihood of timely access to checkups (-5.44 percentage points [PP] difference) but a higher likelihood of having a personal doctor (4.52 PP). Plan for-profit status was associated with a lower likelihood of having access to needed care (-2.24 PP) or having a personal doctor (-4.07 PP). Enrollees in states with Medicaid managed care quality incentives for improving consumer experience of care were significantly more likely to report timely access to specialty care (5.16 PP).

Conclusions: Enrollees from racially and ethnically minoritized groups with poor health status report worse access to care, with characteristics such as for-profit plan status and large plan size being associated with access to care. Strategies to improve care experiences may include targeted outreach, equity initiatives, and strengthening provider networks and availability.