Medicaid enrollee switching among managed care plans.

This case-study (n=41,969) of voluntary switching among Mecklenburg County, North Carolina Medicaid managed care plans showed a low switching rate of 14.5 per 100 member-years over 33 months, or 5.3 averaged annually. Population, plan and plan characteristics, claims and telephone survey data were examined to better understand this important behavioral measure. Switching in Medicaid managed care, which is little studied, is contrasted with the extensive literature on middle class switching. Policy implications included the suitability of Medicaid populations for managed care and the need for more research on switching and disenrollment and the Medicaid innovation of neutral health benefits advising.

A cohort study of former and current Medicaid recipients in two North Carolina counties, 1996-1999.

This article presents findings of a 1998-99 resurvey of Medicaid recipients (adults and children) who were first surveyed in 1996 in Mecklenburg and New Hanover Counties in North Carolina. It reports the insurance status and health care of former Medicaid recipients and compares them with those still on Medicaid in 1998-99 in respect to access to care and satisfaction. Just under half of those who had left Medicaid were without employer-sponsored health insurance (ESI) at the time of the second survey. Former Medicaid recipients without ESI rated their access to healthcare lower than those with Medicaid and former Medicaid recipients with ESI. Over 50% of target respondents in all groups were more positive than negative on access-related variables. But only those on Medicaid in Mecklenburg County had significant increases in satisfaction with health care between 1996 and 1998-99. Those in the control county who were off Medicaid and those still receiving it and former recipients in Mecklenburg showed no significant change. The study has great policy relevance in light of recent national welfare reform.