title: Health services appraisal and the transition to Medicaid Managed Care from fee for service.
abstract: BACKGROUND
  Many states are transitioning fee-for-service (FFS) Medicaid into Medicaid Managed Care (MMC) for people with disabilities.
  
  
  OBJECTIVE
  This study examined managed care's impact on health services appraisal (HSA) and unmet medical needs of individuals with disabilities receiving Medicaid. Key questions included 1) Do participant demographics and enrollment in MMC impact unmet medical needs and HSA? 2) Within MMC, do demographics and continuity of care relate to unmet medical needs? 3) Within MMC, do demographics, unmet medical needs and continuity of care relate to HSA?
  
  
  METHODS
  We collected cross-sectional survey data (n = 1615) from people with disabilities in MMC operated by for-profit insurance companies (n = 849) and a similar group remaining in FFS (n = 766) in one state. Regression analyses were conducted across these groups and within MMC only.
  
  
  RESULTS
  Across Medicaid groups, MMC enrollment was not related to either HSA or unmet needs; health status, having a mental health disability and unmet transportation needs related to HSA and health status, unmet transportation needs and having a mental health or physical disability related to higher unmet medical needs. Within MMC, in addition to better health and fewer unmet medical needs, less continuity of care significantly decreased HSA. Higher unmet transportation needs, poorer health status, having a physical or mental health disability, and less continuity of care significantly decreased unmet medical needs.
  
  
  CONCLUSIONS
  This research points to the importance of meeting unmet needs of individuals in MMC and the need for increased continuity of care as people transition from FFS.
authors.affiliation: Department of Disability and Human Development, University of Illinois at Chicago, 1640 West Roosevelt Road (MC 626), Chicago, IL 60608, USA. Electronic address: rowen4@uic.edu.
authors.forename: Randall
authors.initials: R
authors.lastname: Owen
authors.affiliation: Department of Disability and Human Development, University of Illinois at Chicago, 1640 West Roosevelt Road (MC 626), Chicago, IL 60608, USA.
authors.forename: Tamar
authors.initials: T
authors.lastname: Heller
authors.affiliation: Department of Disability and Human Development, University of Illinois at Chicago, 1640 West Roosevelt Road (MC 626), Chicago, IL 60608, USA.
authors.forename: Anne
authors.initials: A
authors.lastname: Bowers
mesh_terms: D000328:Adult; D003266:Continuity of Patient Care; D003430:Cross-Sectional Studies; D006233:Persons with Disabilities; D018588:Fee-for-Service Plans; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006304:Health Status; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D008329:Managed Care Programs; D008484:Medicaid; D008875:Middle Aged; D014481:United States
keywords: Disabilities; Healthcare satisfaction; Medicaid managed care; Surveys