1. “Advancing Knowledge. Improving Life.” Impact of Ohio Medicaid Eric Seiber, PhD Ohio State University

2. “Advancing Knowledge. Improving Life.” 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

3. “Advancing Knowledge. Improving Life.” Effect of Changes What is the net effect of these changes? early 2004 to late 2008 Examining Medicaid beneficiaries: 1.Access 2.Utilization Comparing Medicaid for entire year to: 1.Private coverage for the entire year (ESI, Privately purchased) 2.Uninsured and Part year coverage Statewide and by Region

4. “Advancing Knowledge. Improving Life.” 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

5. “Advancing Knowledge. Improving Life.” 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

6. “Advancing Knowledge. Improving Life.” Indicators Access 1.Usual source of sick care 2.Rates care as High Quality 3.Harder to obtain care last three years 4.Not obtaining medical care 5.Problems seeing specialist 6.Not obtaining dental care 7.Delayed treatment for cost 8.Major medical cost last 12 months 9.Not obtaining needed drugs Utilization 1.Well Child Visit last 12 mo 2.Doctor visit last 12 mo 3.Never a doctor visit 4.Dentist visit last 12 mo 5.Never a dentist visit 6.Never received eye care 7.Hospital stay last 12 mo 8.ER visit last 12 mo

7. “Advancing Knowledge. Improving Life.” Key Findings - Children Not Obtaining Needed Medical Care, 2004 and 2008

8. “Advancing Knowledge. Improving Life.” Key Findings - Children Any Problem Seeing Specialist, 2004 and 2008

9. “Advancing Knowledge. Improving Life.” Key Findings - Children Delayed Treatment due to Cost, 2004 and 2008

10. “Advancing Knowledge. Improving Life.” Key Findings - Children Any Emergency Room Visit last 12 months, 2004 and 2008

11. “Advancing Knowledge. Improving Life.” Key Findings - Children Overnight Hospital Stay Last 12 months, 2004 and 2008

12. “Advancing Knowledge. Improving Life.” Key Findings - Children Any Emergency Room Visit last 12 months, 2004 and 2008

13. “Advancing Knowledge. Improving Life.” Key Findings - Children Rates their Health Care as High Quality, 2004 and 2008

14. “Advancing Knowledge. Improving Life.” Key Findings - Children Compared to the privately insured, Medicaid children report: 1.Equivalent access to outpatient services 2.Equivalent self-assessed quality of care 3.Equivalent or fewer problems seeing specialists 4.Less likely to identify cost as a barrier to care

15. “Advancing Knowledge. Improving Life.” Key Findings - Children Medicaid Children from 2004 to 2008: 1.Inpatient and ER utilization declined 2.Largest utilization changes in counties transitioning to managed care 3.The reductions in utilization came with lower perceived quality of care

16. “Advancing Knowledge. Improving Life.” Key Findings - Adults Not Obtaining Needed Medical Care, 2004 and 2008

17. “Advancing Knowledge. Improving Life.” Key Findings - Adults Any Problem Seeing a Specialist, 2004 and 2008

18. “Advancing Knowledge. Improving Life.” Key Findings - Adults Delayed Treatment due to Cost, 2004 and 2008

19. “Advancing Knowledge. Improving Life.” Key Findings - Adults Any Emergency Room Visit last 12 months, 2004 and 2008

20. “Advancing Knowledge. Improving Life.” 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

21. “Advancing Knowledge. Improving Life.” 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