Disabling Health Care? Medicaid Managed Care and People with Disabilities in America

Medicaid, America's largest government‐funded health insurance program, plays a pivotal role in providing health services to eight million adults with disabilities. Since the mid‐1990s, many Medicaid programs have aggressively introduced managed care, which reconfigures service delivery using business principles. Most states have insufficient experience in developing managed care plans for Medicaid beneficiaries with disabilities. Middle‐aged adults with physical disabilities present their own constellation of health care issues that is not readily appreciated in health and social services research. This qualitative research examined the implications of Medicaid managed care by conducting in‐depth interviews with a total of thirty respondents with physical disabilities in the age range of 45‐64 years enrolled in a mandatory managed care program in the eastern seaboard of United States. The purpose of the study was to understand their experiences in accessing physical health care services and to ascertain the effects of managed care on their health and well‐being. This study found beneficiaries encounter numerous barriers in accessing preventative, treatment, and acute care services. Overall, access to care is difficult when the required service is expensive (eg. new wheelchairs, repairs to wheelchairs, special beds, and expensive medications). When services are delayed or denied, physical conditions, emotional and economic well‐being, and social participation are negatively affected. Although the lived realities of accessing managed care services that surfaced in this study can be viewed as reasonably representative of the experiences of disabled Medicaid beneficiaries given the cross‐disability nature of the sample, the study does not claim generalizability across the country. States have considerable latitude in designing their Medicaid programs through decisions such as eligible services, calculation of income and assets for enrollment, and optional categories for benefits. As Medicaid programs face uncertainty in coming years, first‐hand accounts of the most vulnerable populations provide invaluable insights to evaluate the consequences of neo‐liberal health reforms.