Study Says Access Limited Under Maryland’s Medicaid Managed Care Program

Administrative problems within Maryland's Medicaid managed care program, HealthChoice, "are limiting" recipients' access to care, an Advocates for Children and Youth report states. In 1997, Maryland transferred its Medicaid program to managed care, under which eight HMOs coordinate care for Medicaid recipients. The state pays the HMOs a monthly, per-member fee. For its report on the state's system, Advocates for Children and Youth hosted focus groups with Baltimore parents and conducted interviews with managers of pediatric practices around the state. The report notes several of the system's "problems," including "too few doctors," children being assigned to doctors other than their usual pediatricians, long waits to receive care and problems securing care for newborns, who have not yet been enrolled in a HealthChoice HMO. For example, the report cites one child who waited for six months to get an appointment to remove a bullet from his chest. Advocates for Children and Youth Health Policy Director Carol Fanconi said, "What we've got is a complex managed-care system placed on a population that has a number of barriers to care, without the necessary consumer education to help them overcome the barriers. And some of those barriers don't need to be there at all." State Deputy Health Secretary Debbie Chang questioned Advocates for Children and Youth's report methodology, stating that it might not yield a "representative sample," the Baltimore Sun reports. Chang added that the state's own surveys indicate that "problems are not widespread." She said, "We're concerned about the issues that have been raised, but we don't want people to generalize to the whole program." Advocates for Children and Youth Public Policy Director Matthew Joseph countered that although the report's methods "did not allow precise measurement" of the system's problems, the report only highlighted "difficulties" if they "came up several times in interviews." Moreover, he said that even if only 10% of the 300,000 children enrolled in HealthChoice are affected by such problems, "a problem facing 30,000 or more children in Maryland merits a response." Dr. Charles Schubin, a member of the state's Medicaid advisory committee, admitted that low payments have resulted in many doctors limiting the number of Medicaid patients they treat, but said, "Overall, the care patients are getting is still better than the old system" (Salganik, Baltimore Sun, 11/1).