WVU study finds controversial Medicaid program results in less medical care

MORGANTOWN, W.Va. – West Virginia University researchers studying the effectiveness of a new Medicaid program have pinpointed several key failings, concluding that the program ended up reducing Medicaid services for at least 90 percent of the West Virginia population that receives them.

The Medicaid program, called Mountain Health Choices, grants enrollees additional services if they make certain commitments such as showing up at all their medical appointments and staying out of the hospital emergency room except for bona fide emergencies. Members who do not choose to sign the contract, or who fail to adhere to it, receive scaled-back Medicaid services.

Scaled-back benefits might result in people covered by Medicaid making fewer trips to the doctor and doing without medicines and mental-health services, the researchers said.

“Since most Mountain Health Choices members are children, the impact on their lives can be huge if their parents either don’t grasp the program or don’t adhere to the rules,” said Michael Hendryx, Ph.D., the project’s lead investigator and associate professor in the WVU Department of Community Medicine. “Children might end up being punished for their parents’ lack of understanding or lack of compliance. On the plus side, we found widespread support for the concept of people taking personal responsibility for their behaviors and choices regarding their health.”

Under a $100,000 Robert Wood Johnson Foundation grant, researchers from the WVU Institute for Health Policy Research completed the first review since statewide implementation began in late 2007. The WVU team interviewed four stakeholder groups: state Medicaid representatives, patient advocacy organizations, professional association representatives, and healthcare providers and their staffs. Among their findings:

  •  The program is too complex for many participants to understand, resulting in some target populations being underserved such as people with severe mental health problems.
  •  Stakeholders question the premise that a simple contract is sufficient to change people’s behavior.
  •  The state moved ahead with implementation before the rewards component of the program was ready, so no means existed to reinforce people who signed the contract or improved their behaviors.

WVU researchers’ greatest concern is that 90 percent of Medicaid recipients fell into the “basic benefit” version of the program.  The basic plan offers a scaled-back version of traditional Medicaid benefits. It restricts, for example, the number of prescription medicines allowed and coverage for mental health services.

Hendryx said, “A recurrent theme of the criticism is that not enough outreach took place to keep Medicaid recipients informed. This is a highly transient population, and many have a low level of literacy. Most of those interviewed believe that a large proportion did not understand the informational mailings that were sent out, especially the initial mailings.”
On the flip side, one of the strengths of the Mountain Health Choices program is that stakeholders believe in its health-improvement goals, and they acknowledge that a complex program like this was bound to have some problems that could still be worked out in the future, he said.

A copy of the full report can be found at http://www.hsc.wvu.edu/wvhealthpolicy/reports_2008.htm.



For more information:
Andrea Brunais, HSC News Service, 304-293-7087
AB: 4-21-09

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