Almost a quarter of the population is covered by Medicaid. But not everyone who is on Medicaid knows it. Ashley Tallevi examines the implications of privatization features that leads to the misidentification of Medicaid as private insurance in the Journal of Health Politics, Policy and Law**:
When I measured privatization simply using managed care enrollment, which is the most widely used measure of Medicaid privatization in studies of Medicaid underreporting, I found no relationship between privatization and Medicaid self-reporting. However, when I specified administrative features of Medicaid managed care organizations (MCOs) that obscure government’s role, I found that these administrative features are related to the underreporting of Medicaid enrollment. Medicaid recipients become less likely to report their enrollment when MCOs mix Medicaid recipients and commercial enrollees in the same plan and when Medicaid MCOs include the private company’s name in the MCO plan name. I also found that, when this misreporting occurs, Medicaid enrollees are frequently reporting enrollment in private insurance plans.
Charles Gaba was curious about this question in 2015 and his data is stunning:
it’s jaw-dropping to discover that not only does Medicaid itself operate under more than 100 different names (some states have several separate or overlapping Medicaid programs), but that when you include CHIP and “other” state-funded healthcare programs the total number swells to over 200.
Going back to my main point: Of the 106 different Medicaid programs, only 15 of them (from just 12 states) have the word “Medicaid” in their actual publicly-branded name. For instance, in Connecticut, “Medicaid for Low-Income Adults” is referred to as “HUSKY Part D”. In Wisconsin, their main Medicaid program is called “BadgerCare”, but they do have another variant called “Wisconsin Medicaid Purchase Plan” or MAPP for short.
My last position at UPMC Health Plan was on the Medicaid team where I optimized risk adjustment revenue strategies for UPMC for You, the Medicaid managed care component of the company. This rings true to me. Every piece of advertising, branding and communication that I can remember focused on UPMC for You. Medicaid or Medical Assistance was seldom mentioned anywhere other than the Monday morning data geek team meeting.
One of the things that happily surprised me last year was the power of the Medicaid push back on the Republican health cut bills. Not everyone on Medicaid knew that they were on Medicaid although I would imagine that the parents of medically fragile children and the beneficiaries with significant, persistent high cost needs were very well aware of how Medicaid allows them to structure their life even if they were on Badger Care or Apple Care or UPMC for You or whatever else.
Medicaid is a critical resource for lots of families, but the naming conventions hides the value of that resource to some beneficiaries and the broader public.
** Ashley Tallevi; Out of Sight, Out of Mind? Measuring the Relationship between Privatization and Medicaid Self-Reporting. J Health Polit Policy Law 1 April 2018; 43 (2): 137–183. doi: https://doi.org/10.1215/03616878-4303489
matyroshka
Very good point. I work as a freelance editor, frequently on Medicaid projects in various states, and it is truly the hero with a thousand faces. In my day job at a clinic that is a Medicaid health home, I am often astounded by how many people have no idea they are on Medicaid. This allows them all kinds of misapprehensions about who is getting the “welfare” they disparage so freely.
RSA
Fascinating. Not unexpected, but nice to see analysis of the issue.
guachi
People love Medicaid. Just don’t call it Medicaid. You can cut Medicaid because the Poors use it. But you can’t cut Thing-That-Is-Medicaid-In-All-But-Name
satby
@matyroshka: @guachi: the misnaming of Medicaid allows Republicans to have it both ways; they get money from the feds for their Medicaid enrollment while getting even people enrolled in it all enraged about the moochers on Medicaid. They aren’t on Medicaid, they’re on HIPP or Kynect.
gvg
There are also stigmatism issues. People don’t necessarily want it announced to everyone in line with them. Other people assume they know what it means and are quick to accuse of fraud. When I was a foster mom, the young kids automatically qualified for wic. It didn’t even look at our income which is correct but my sister in her nice car avoided using them because people would jump to wrong conclusions. I did the buying with my older car. As a financial aid counselor, sometimes people reported fraud to us and we were required to investigate. Rarely was there anything to it, just other people assuming they knew facts. Frankly if someone is struggling financially, they usually prefer to hide it and also a lot of people with a serious medical condition like cancer, don’t tell everyone they meet that they have thousands in bills….So I think the rebranding is probably on purpose with an unintended consequence. they probably need to do some sub branding on statements so people know what they need to defend coming voting times. Just put some small but not tiny pring under BadgerCare: a medicaid funded program or something like that on the inside of the envelopes.
Ohio Mom
Having private companies administer Medicaid also provides lots of opportunities for skimming of course.
There was an article in the Cincinnati Enquirer a week or two ago about how privatized Medicaid companies work with pharmacies to overcharge Ohio. I can’t find it at the moment though. I’ll keep trying.
Ohio Mom
@Ohio Mom: I found it: “CVS accused of using Medicaid rolls in order to push out competition” (sorry I don’t know how to link properly).
Apparently CVS manages pharmacy benefits for four out of the five Ohio managed Medicaid plans and is gaming the system.
Proving once again that the idea that competition is good for health coverage is malarkey.
Arclite
@Ohio Mom: Hey, to link:
1. Go to the story and copy the URL
2. Highlight the text you want to link in your comment.
3. Click the link button at the top of the comment box.
4. A popup box will say “Enter the URL.” You can paste the URL you copied in step 1 in the box and click OK.
Arclite
Seems like there’s an easy fix for the naming problem: require the word “Medicaid” in the product name.
Alexi
Then there’s the Medicare Savings Programs, which are —you guessed it— Medicaid as well. I think it’s like all the tax expenditures that allow middle class folks to think they never get any government assistance while they collect subsidies for mortgages, student loans, child care, etc. Time to make those connections more transparent.