Consumer / Employer, Payers

Report: How Does Medicaid Perform Compared To Other Forms of Coverage?

A higher share of Medicaid beneficiaries rate their physical and mental health as fair or poor compared to adults with Medicare, employer-sponsored insurance or Marketplace coverage, according to a new KFF report. However, 83% of Medicaid enrollees gave their health insurance a positive rating.

A new report from KFF provides insight into how Medicaid beneficiaries view their health coverage and how it compares to other types of coverage.

The report, published Monday, is based on findings from the KFF Survey of Consumer Experiences with Health Insurance. It was conducted from February to March and included a sample of 3,605 U.S. adults.

It found that a higher share of Medicaid beneficiaries rate their physical and mental health as fair or poor compared to adults with Medicare, employer-sponsored insurance or Marketplace coverage. About 32% of Medicaid enrollees said their physical health was fair or poor and 36% said their mental health was fair or poor.

However, 83% of Medicaid enrollees gave their health insurance an “excellent” or “good” rating. When broken down by race and ethnicity, most Medicaid enrollees still gave Medicaid a positive rating, with White adults the most likely to do so. About 44% of White Medicaid enrollees gave an “excellent” rating, compared to 29% of Black enrollees and 34% of Hispanic enrollees. 

Still, more than half of Medicaid beneficiaries said they’ve had an issue with their insurance in the last year. This was also the case for those enrolled in Medicare, employer-sponsored insurance and Marketplace coverage, but the problems differ depending on the coverage.

“Those with private coverage are more likely to experience cost-related issues while those on Medicaid are more likely to report problems with prior authorization and provider availability,” KFF said. The researchers noted that similar shares of Black, White and Hispanic adults enrolled in Medicaid experience these issues with prior authorization and provider availability.

The report also found that Medicaid enrollees are more likely to report having a decline in health and not being able to receive recommended treatment than those with Medicare or employer-sponsored insurance (adults with Marketplace coverage had similar rates to Medicaid enrollees). On the flip side, Medicaid beneficiaries were less likely to say that they had to pay more than they anticipated for services compared to other insurance types.

Despite challenges faced by Medicaid enrollees, KFF said that there is a possibility for change in the future.

“Pending federal rules addressing provider availability for Medicaid managed care enrollees may improve access to care for these enrollees,” KFF said. “Proposed regulations from the Biden administration may streamline prior authorization processes and impact wait times but fall short of [Office of the Inspector General] recommendations for stronger state monitoring of denials and required automatic external medical reviews.”

Photo: designer491, Getty Images

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