Underutilization of Medicaid Services in African American Families

Purpose: Many families in the United States face barriers to healthcare despite the availability of Medicaid. Studies have consistently noted healthcare disparities between ethnic minorities and whites in health care services utilization and perceived quality of care. The proportion of uninsured Medicaid-eligible children and the proportion enrolled in Medicaid varies by racial and ethnic group. Hispanics have the highest uninsured rate among Medicaid-eligible children, while African-American children are most likely to be enrolled in Medicaid (GAO, 1998). Nonetheless, African American children enrolled in Medicaid use health services much less than White children, even when controlling for socioeconomic status and other factors affecting service use (Buescher, Horton, Devaney, Roholt, Lenihan, Whitmore, et al, 2003). While several reports have highlighted barriers to receiving healthcare, few have identified explanations for these findings. This study, using a community engagement theoretical framework, addresses the research question of why African American families are not using Medicaid services.

Method: A random sample of 71 African American families with Medicaid Managed Care (MMC) enrollees (ages 20 years and younger) was selected from a Health and Human Services database. Using a 31- item questionnaire in a 30 minute telephone interview, data were collected and analyzed. Frequency counts and thematic analyses (Miles & Huberman, 1994) of the transcripts were conducted by two coders using qualitative data analysis software  HyperRESEARCH. Conceptually clustered matrices were constructed to determine thematic patterns and the data analysis coding was checked for inter-rater reliability.

Results: Survey respondents reported MMC enrollees do not use Medicaid services due to transportation problems (n=35, 45.9%), difficulty getting to appointments (n=30, 40.5%), excessive wait times in the office for an appointment (n=30, 40.5%), and locations that are hard to get to (n=28, 37.8%).  Some also mentioned problems with cultural barriers, including racism. When asked what could be done to improve the use of Medicaid services, in addition to improving transportation access, simplifying paper work, and increasing appointment times, respondents suggested improving service delivery by offering better customer service and providing Medicaid services in the community facilities such as schools.  Demographic descriptions of the respondents and their children as well as information about their use of Medicaid services will be provided.

Implications: Recommendations following from the study are to improve and track the currency of MMC enrollees’ contact information, and to reduce transportation and accessibility problems by locating services more conveniently. Making personal contact and engaging Medicaid recipients in their communities reiterates the importance of community engagement in the delivery of social services. While practices related to racism could not be confirmed as an explanatory factor for the respondents’ low use of Medicaid services, its existence could also not be ruled out. Service delivery concerns affirmed in the literature about Medicaid services focused on the problems with transportation and the availability and accessibility of services. However, this study also raised questions about the need for further research about customer service delivery related to Medicaid services.