Medicaid Managed Care Plans and Access to Care: Results from the Kaiser Family Foundation 2017 Survey of Medicaid Managed Care Plans

The Kaiser Family Foundation Survey of Medicaid managed care organizations (MCOs) was fielded from April to September 2017 to investigate how MCOs provide and monitor access to care for Medicaid enrollees. In particular, the survey aimed to capture information about MCO policies, procedures, and strategies for ensuring optimal access to care, as well as MCOs’ top challenges and priorities in regards to access. The survey also collected information on key characteristics of MCOs, such as the populations enrolled and the delivery systems and payment models used, and the impact of current policy developments on MCO operations. The Kaiser Family Foundation contracted with NORC at the University of Chicago to develop and field the web-based survey.

Survey Sample

The target population included all comprehensive Medicaid MCOs in the 39 U.S. states (including the District of Columbia) that use comprehensive managed care for any Medicaid enrollees. Eligible plans included any plan that had a 2016 Medicaid MCO contract (as several survey questions referred to plan operations in 2016) and was active during the data collection period in 2017 (as some survey questions referred to future/current plan operations). The final sample frame comprised 280 MCOs.¹ MCO executives, such as Presidents, Chief Executive Officers (CEOs), Chief Operating Officers (COOs), Directors of State Programs, Directors of Medicaid Programs, Directors of Marketing and/or Communications, and Directors of Government Regulations or Government Affairs, were asked to complete the survey on behalf of their MCO. Each MCO was provided with a unique survey link, and multiple individuals within each MCO could collaborate to complete the survey.

Field Period

Data collection began on April 17, 2017 and concluded on September 21, 2017. The survey was distributed by email to executives at each MCO. Outreach to plan contacts occurred multiple times throughout the field period to encourage participation. The survey was offered in English only. A PDF of the survey instrument was provided to all respondents along with a link to the web-based survey.

Survey Response Rate and Sample Representation

The response rate was calculated using American Association for Public Opinion Research (AAPOR) standards for establishment surveys, which is the number of completes divided by the number of eligible reporting units (which in turn is the sum of complete and partial interviews, refusals, non-contacts, and other sample units). Out-of-scope cases are excluded as they are incapable of participating.

In data processing, NORC identified three cases that had complete survey data or were missing only data for the first section (respondent contact information) but did not formally complete the survey by hitting “Save and Submit.” These cases were re-coded as completes at the end of data collection. All other cases with questionnaire responses were classified as Partial Completes. Cases that had timestamp data indicating that they reviewed the web survey, but did not respond to any survey questions, were classified as Non Response.

The final plan participation calculations are as follows:

Table A1: Sample Definition and Plan Participation Rate
Invited MCOs	280
Eligible Plans Not Inviteda	2
Invited Plans Excludedb	5
Eligible Plans	277
Complete Surveys	95
Survey Response Rate	34.3%
Partially Complete Surveysc	3
a Two MCOs were identified post-data collection as having been eligible for inclusion in the survey. These two plans were not included in the final sample frame nor were they invited to participate during the data collection period; however, they are included in the final data file and response rate calculations. b Five plans were dropped from the sample frame as they were found to be ineligible after the initial email was sent. These plans were excluded due to being purchased by another plan already on the sample frame or ceasing to operate as a Medicaid MCO in the state. c These plans completed a majority of survey sections and were included in the analysis but not the survey response rate.

Reported results are not weighted. In reporting data, we further included data from three partial complete plans that completed the majority of the survey (partial completes that did not complete a majority of the survey were dropped from the analysis). Comparison of plans represented in data reporting to the universe of eligible plans (Table A2) indicates that included plans represent 31 of 39 states and 38% of total comprehensive Medicaid managed care enrollment.² Reporting plans were slightly more likely than the universe of plans to be non-profit and to operate in states that expanded Medicaid under the ACA. Compared to the universe of eligible plans, reporting plans were similar in average Medicaid enrollment, geographic distribution, and state Medicaid MCO penetration. When appropriate, we interpret findings in light of the higher likelihood of responding plans being non-profit plans in Medicaid expansion states.

Table A2: Comparison on Plans in Survey and Universe of Plans
	All MMC Plans	Plans in Survey
Number of states	39	31
Total MMC enrollmenta	48 million	18 million
Profit Statusb Non-Profit For-Profit	48% 47%	64% 34%
In Medicaid expansion state	72%	68%
Average plan enrollmenta	185,130	172,908
Geographic Region Northeast South Midwest West	19% 28% 24% 30%	18% 31% 25% 26%
At least 80% of state Medicaid population enrolled in Medicaid MCO	57%	57%
NOTES a Based on plans for which enrollment is known. Approximately 14% of all plans have unknown enrollment. See: The Kaiser Family Foundation State Health Facts. Medicaid MCO Enrollment. Data Source: State Medicaid managed care enrollment reports for the timeframe indicated unless otherwise noted; available at: https://www.kff.org/other/state-indicator/medicaid-enrollment-by-mco/. b Approximately 5% of all plans profit status could not be determined based on online searches.