Impact of Ohio Medicaid

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Impact of Ohio Medicaid Eric Seiber, PhD

Ohio State University
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Medicaid Changes

• Many changes in Ohio Medicaid since 2004 Ohio
  Family Health Survey
• Changes include
• Eligibility changes for parents, foster youth,
  and disabled children
• New federal documentation rules for eligibility
• Expansion of Medicaid managed care

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Effect of Changes

• What is the net effect of these changes?
• early 2004 to late 2008
• Examining Medicaid beneficiaries
• Access
• Utilization
• Comparing Medicaid for entire year to
• Private coverage for the entire year
  (ESI, Privately purchased)
• Uninsured and Part year coverage
• Statewide and by Region

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Children Groups

• Children Ages 0 17
• Medicaid coverage entire year
• All Medicaid Children
• Medicaid Managed Care Markets
• In 2004, Mandatory counties, Preferred, None/Vol
• By 2008, all counties were mandatory
  participation
• Private coverage entire year
• Uninsured and Part year coverage

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Adult Groups

• Adults Ages 18 64
• Medicaid coverage entire year
• All Medicaid adults
• Healthy Start/Healthy Families
• Aged, Blind, Disabled (ABD)
• Undetermined Medicaid
• Private coverage entire year
• Uninsured and Part year coverage

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Indicators

• Access
• Usual source of sick care
• Rates care as High Quality
• Harder to obtain care last three years
• Not obtaining medical care
• Problems seeing specialist
• Not obtaining dental care
• Delayed treatment for cost
• Major medical cost last 12 months
• Not obtaining needed drugs

• Utilization
• Well Child Visit last 12 mo
• Doctor visit last 12 mo
• Never a doctor visit
• Dentist visit last 12 mo
• Never a dentist visit
• Never received eye care
• Hospital stay last 12 mo
• ER visit last 12 mo

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Key Findings - Children
Not Obtaining Needed Medical Care, 2004 and 2008
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Key Findings - Children
Any Problem Seeing Specialist, 2004 and 2008
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Key Findings - Children
Delayed Treatment due to Cost, 2004 and 2008
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Key Findings - Children
Any Emergency Room Visit last 12 months, 2004 and
2008
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Key Findings - Children
Overnight Hospital Stay Last 12 months, 2004 and
2008
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Key Findings - Children
Any Emergency Room Visit last 12 months, 2004 and
2008
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Key Findings - Children
Rates their Health Care as High Quality, 2004 and
2008
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Key Findings - Children

• Compared to the privately insured, Medicaid
  children report
• Equivalent access to outpatient services
• Equivalent self-assessed quality of care
• Equivalent or fewer problems seeing specialists
• Less likely to identify cost as a barrier to care

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Key Findings - Children

• Medicaid Children from 2004 to 2008
• Inpatient and ER utilization declined
• Largest utilization changes in counties
  transitioning to managed care
• The reductions in utilization came with lower
  perceived quality of care

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Key Findings - Adults
Not Obtaining Needed Medical Care, 2004 and 2008
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Key Findings - Adults
Any Problem Seeing a Specialist, 2004 and 2008
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Key Findings - Adults
Delayed Treatment due to Cost, 2004 and 2008
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Key Findings - Adults
Any Emergency Room Visit last 12 months, 2004 and
2008
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Key Findings - Adults

• Compared to privately insured adults, Medicaid
  adults report
• More problems entering the health care system
• Fewer cost barriers once in the system
• The ABD population reported higher utilization
  yet lower access than Healthy Start/Healthy
  Families enrollees

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Conclusions

• Access and Utilization
• For low income children, Medicaid produces
  results similar to the privately insured
• Results were mixed for Medicaid adults,
  especially ABD adults
• Costs
• Complete picture will contrast changes in access
  and utilization with changes in total costs per
  beneficiary