Impact of Facilitating Access to Chronically Ill Medicaid Patients

Background and Purpose: The new health care reform legislation requires states to expand Medicaid coverage to additional low income individuals and childless adults beginning in 2014. Medicaid is one of the few health insurance programs that not only covers visits to providers but also facilitates access to non-emergency but medically necessary care through provision of transportation services (Rosenbaum, Lopez, Morris, & Simon, 2009). Medicaid covers some of the most vulnerable segments of the society who live in impoverished and medically underserved areas. Lack of a vehicle or the inability to pay for transportation, dependence on relatives or friends, and geographic distance from providers, lead to missed appointments, late arrivals, delayed care, and poorly managed chronic conditions (Arcury, 2005; Rust, 2008). Hughes-Cromwick (2005) and Kim (2009) found that providing transportation to those without transportation, which consists of an unusually high proportion of the chronically ill, female, aged, disabled, and racial minorities, leads to improved quality of life and cost-effectiveness for 12 chronic conditions, and cost- savings for four chronic conditions. This study examines the impact of state provision of Non-Emergency Medical Transportation services on management of care by chronically ill Medicaid patients in one state. Methods: Data provided by a mid-western state Medicaid agency consisted of 18, 219 chronically ill Medicaid recipients. Sample was restricted to recipients 21 years or older, and included information on age, sex, race-ethnicity, zip-code of residence, name of county, trip distance, type of chronic condition, number of visits to providers, and transportation dates. Rural-Urban Commuting Area Code (RUCA) was used to identify types of rural areas. Literature on disease management provided information on number of visits required per year for appropriate management of each chronic disease condition. Data on the actual number of visits made by each respondent in the racial-ethnic and rural-urban groups were assessed, and patients were classified as well managed or poorly managed. Regression analyses were completed to assess impact of non-emergency transportation services on well managed/poorly managed care controlling for the effects of demographic variables, type and number of chronic conditions, and mileage from provider Results: Demographic distribution showed a higher proportion of American Indians, males, and older Medicaid recipients in rural and isolated rural areas than in urban areas. Hypothesized effect of the impact of state provision of transportation services on use of medical services was supported (p<.01). Controlling for other factors, for each chronic condition (Asthma, Congestive Heart Failure, Hypertension, Diabetes, and Kidney Disease), Medicaid beneficiaries who used state provided transportation services were significantly more likely to meet the required number of visits for well-managed care than those who did not use the services. These results were consistent across urban, rural, and isolated rural areas. Conclusion and Implications: Results suggest that federal efforts to improve access by expanding medical coverage to the medically needy will not be realized without enabling access through improved transportation provisions. As the federal government works with each state's distinctive Medicaid program to implement the new health reform legislation, the implications of above findings are discussed.