I am insured but how do I use my coverage: Lessons from the front lines of Medicaid reform

摘要

Abstract Objective When Illinois expanded Medicaid in 2014, the state also passed legislation requiring that 50% of Medicaid recipients be enrolled in a managed care plan. The purpose of this project was to identify the barriers and facilitators that Medicaid enrollees have understanding and using their managed care plans. Design and Sample In this descriptive study, participants included Medicaid enrollees, community workers, health care navigators, and a state health insurance representative. Measures Methods included focus groups, interviews, and surveys. Results The challenges that Medicaid enrollees had transitioning from a state administered Medicaid program to private managed care program were grouped into three general themes: Individual Barriers, Structural Barriers, and Questions about Medicaid . Conclusion The Medicaid expansion in Illinois increased the number of people who receive health insurance. However, participants faced significant barriers using and understanding managed care because of their lack of previous experience using health insurance and the limited support provided by the state.