Beginning in 2011, seniors and persons with disabilities (SPDs) in 16 counties with Medi-Cal fee-for-service were required to choose a managed care plan or be assigned to one. After one year, approximately 240,000 SPDs had made the transition to managed care.
Advocates for the affected groups expressed concern about this shift. Many SPDs, burdened with multiple chronic conditions and limited physical or mental capacity, use far more health care services than other Medi-Cal enrollees.
March 2015 Update
Health Affairs has published this study of seniors and persons with disabilities enrolled in Medi-Cal and who were recently transitioned to a managed care plan.
In this report, researchers from the University of California, Berkeley, present findings from a survey of more than 1,500 SPD Medi-Cal enrollees who made the transition. The goals of this research, supported by CHCF and the California Department of Health Care Services (DHCS), were to evaluate the enrollee experience and to identify groups of enrollees that would benefit from additional assistance during and after future transitions.
- Overall, 70% to 80% reported that managed care provided health services that were the same as or better than those available from fee-for-service caregivers.
- SPDs in the worst health and those struggling with functional and cognitive impairment reported the most difficult transitions.
- People were more likely to experience challenges if they rated their health status as “poor,” had activity and mobility limitations, had difficulty reading health care materials, or were African American, Latino, or more than 65 years old.
- SPDs in the worst health and those struggling with functional and cognitive impairment reported the most difficult transitions, were least likely to navigate their new plans effectively, and were most vulnerable to care disruptions.
These obstacles to optimal care could further compromise SPDs’ health, quality of life, and ability to live in the community.
The report offers suggestions for improving transitions to managed care involving populations with complex needs, including those dually eligible for Medicare and Medicaid, and examples of actions taken by DHCS in response to the study’s findings.
The complete report is available under Document Downloads.