Assessing Medicaid recipient access and satisfaction - Fee-for-service, case management, and capitation

Medicaid increasingly requires enrollment in managed care programs This stu dy assessed access to care, satisfaction with care, and appointment wait ti mes during the transition from fee for service to managed care using three annual Medicaid recipient surveys. There was little evidence of dissatisfac tion or poorer access among managed care recipients. Fee-for-service recipi ents, compared to primary care Ease management, reported greater general (9 1 vs. 78%, p < .01) and specialty care access (92 vs. 80%, p < .01). When a ppointments were required, adult HMO enrollees, compared to case management , had longer waits for routine care in the second (5.8 +/- 8.2 days vs. 4.0 +/- 6.6) and third surveys (5.5 +/- 6.9 days vs. 3.8 +/- 7.3); waits for o ther appointments did not consistently differ by program. There were no sig nificant program differences in overall satisfaction. Findings am tempered by the potential for response bias and geographic confounding. Continued mo nitoring is crucial to assure that access and satisfaction remain high in M edicaid managed cam.