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 Front Cover
 About this chartbook
 Table of Contents
 Summary of major findings
 Introduction
 Methods
 Describing the populations
 Experiences with care and...
 Experiences with care by race/...
 Glossary
 Acknowledgement


UF



Florida Medicaid adult enrollee satisfaction : a chartbook comparing managed care arrangements and fee for service
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Permanent Link: http://ufdc.ufl.edu/UF00091284/00001
 Material Information
Title: Florida Medicaid adult enrollee satisfaction : a chartbook comparing managed care arrangements and fee for service
Physical Description: Serial
Language: English
Creator: Florida Center for Medicaid and the Uninsured, College of Public Health and Health Professions, University of Florida
Publisher: Florida Center for Medicaid and the Uninsured, College of Public Health and Health Professions, University of Florida
Place of Publication: Gainesville, Fla.
Creation Date: 2004
 Subjects
Genre: serial   ( sobekcm )
 Record Information
Source Institution: University of Florida
Holding Location: University of Florida
Rights Management: All rights reserved by the source institution and holding location.
System ID: UF00091284:00001

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Table of Contents
    Front Cover
        Front Cover
    About this chartbook
        Page 1
    Table of Contents
        Page 2
    Summary of major findings
        Page 3
        Page 4
        Page 5
        Page 6
        Page 7
    Introduction
        Page 8
        Page 9
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    Methods
        Page 20
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        Page 24
    Describing the populations
        Page 25
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        Page 59
    Experiences with care and satisfaction
        Page 60
        Page 61
        Page 62
        Page 63
        Page 64
        Page 65
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        Page 111
        Page 112
        Page 113
        Page 114
        Page 115
    Experiences with care by race/ethnicity
        Page 116
        Page 117
        Page 118
        Page 119
        Page 120
        Page 121
        Page 122
        Page 123
        Page 124
    Glossary
        Page 125
        Page 126
    Acknowledgement
        Page 127
        Page 128
Full Text




Florida Medicaid Adult Enrollee Satisfaction:

A Chartbook


Comparing
and


Managed Care Arrangements
Fee-for-Service, 2004


Prepared by:


Florida Center for Medicaid and the Uninsured
Shaping i H ealihcare Policy


Funding for this project provided by:

FLORIDA -
MEDICAID












This chartbook presents an analysis of adult enrollee satisfaction with the Florida Medicaid
program. Demographics and program satisfaction are reported for the Medicaid program overall,
as well as by the type of Medicaid program or plan of the respondent. The Medicaid programs
described in this report include: Medicaid HMOs (as a group), Medicaid Fee-for-Service (FFS),
MediPass, the Minority Physician Network or MPN, and the Provider Service Network or PSN.
MediPass data are presented according to whether the respondents resided in a county which
offers only MediPass (MediPass "No Choice" counties), or in a county which offers other types of
plans (MediPass "Choice" counties). MPN data are presented according to whether the
respondents were served by NetPass or PhyTrust.

This chartbook is intended to be a graphical and easy-to-use guide for program administrators
and others who are interested in understanding Medicaid enrollees' experiences with care, and
the differences between the various Medicaid programs. In the interest of brevity, many technical
and scientific details regarding methodology are summarized here. A more complete description
can be found in the Technical Appendix which accompanies this document. Complete survey
instruments, frequencies for each item, and detailed eligibility category information may also be
found in this appendix.











SECTION 1: SUMMARY OF MAJOR FINDINGS ................................. 3
SECTION 2: INTRODUCTION .................................................8
SECTION 3: METHODS ..................................................... 20
SECTION 4: DESCRIBING THE POPULATIONS ................................ 25
A. Demographics ...............................................26
B. Health Status ................................................ 43
SECTION 5: EXPERIENCES WITH CARE AND SATISFACTION .................... 60
A. Primary Care ................................................61
B. Specialty Care ............................................... 68
C. OtherTypes of Care ............... ................. ....... 71
D. Communicating with Providers ................ ................ 92
E. Plan Administration ........................................ 109
SECTION 6: EXPERIENCES WITH CARE BY RACE/ETHNICITY. ................. 116
GLOSSARY .............................................................. 125
ACKNOWLEDGEMENTS ................................................... 127








Summary of Major Findings










In terms of satisfaction with care, the major finding presented in this chartbook is that adult Medicaid
enrollees overall are satisfied with the care they receive. Enrollees also reported positively on many
important indicators of health care quality.
Nearly three-quarters (73%) of enrollees reported that it is "not a problem" finding a satisfactory
primary care provider in Medicaid. This figure is more favorable than the national average (67%)
among Medicaid adults. All of the Medicaid programs reported positively on this measure, though
the FFS and PSN enrollees reported particularly positively.
Enrollees were also overwhelmingly positive about the timeliness of acquiring both non-urgent and
urgent care. Sixty percent of enrollees reported that they "always" got non-urgent care appointments
as soon as they wanted. This figure also compares quite favorably with the national average of
48%. The FFS group reported most positively on this measure, while the MediPass No Choice
group, which is made up of mostly rural-dwellers, reported least favorably. Sixty percent of enrollees
reported that they "always" got urgent care as soon as they wanted it. Again, this figure compares
favorably with national average of 56% among Medicaid-enrolled adults. Reports from the PSN
were overwhelmingly superior to those of the other groups on this measure, with 75% of
respondents reporting that they "always" got urgent care as soon as they wanted it. It is noteworthy
that the PSN's performance on this measure outshines that of the national averages for Medicaid,
commercial health plans, and Medicare.
Other positive findings from the chartbook include:
* Eighty percent of enrollees surveyed reported having a usual source of care
* More than three-quarters of enrollees reported that their providers "usually" or "always" spent
"enough" time with them
* The vast majority (86%) reported that they were "usually" or "always" involved in their health care










decision making, and 80% report it was "not a problem" to get their providers to agree with them
on the best way to manage their health conditions.
Though most of the findings were positive, there were some areas in which the reports were less
favorable. Providing adequate access to specialty care has long been a challenge for Medicaid
programs across the country. Reports from Florida Medicaid enrollees suggest that experiences
vary widely. A large portion (68%) of respondents indicated it was "not a problem" to see a
specialist in Medicaid. This figure compares favorably to the national Medicaid average of 64%.
However, a significant portion of enrollees, 32%, report having a problem. More than half of these,
or 20% overall, reported it was "a big problem," and this figure compares unfavorably to the
national Medicaid average of 17%. Some of this variation in experiences can be explained by the
significant differences in the reports of the various program components. The most favorable
ratings came from the FFS population, in which 76% reported it was "not a problem" to see a
specialist, and 14% reported it was "a big problem." The least favorable ratings came from the
MediPass No Choice group, in which 58% reported it was "not a problem" and 30% reported "a big
problem." (The No Choice group is by-and-large made up of enrollees residing in rural counties,
where access to specialty care is as much a function of geography as it is of program structure.)
Most enrollees in Medicaid (70%) reported it was "not a problem" to get needed care, tests, or
treatment through Medicaid. However, 30% reported having a problem, and almost half of these,
or 14% overall, indicated it was "a big problem." National Medicaid figures show 75% of enrollees
reporting that, in their Medicaid program, it was "not a problem" to get care, tests or treatment, and
only 9% reporting having "a big problem."
Getting assistance by phone was problematic for many Medicaid enrollees. More than half (55%)
of enrollees surveyed reported having problems getting this assistance, with more than half of
these, or 34% overall, reporting a "big problem" and 22% overall reporting "a small problem." Only










45% of those surveyed reported it was "not a problem" to get this assistance. The program
components did not vary significantly on this measure, though it is noteworthy that the Medicaid
HMO enrollees did appear to report considerably more favorably. (A statistical comparison of the
HMO group with the other groups is outside the scope of this chartbook.) It is important to consider
that the survey question does not differentiate between centralized Medicaid customer service lines
and program-specific customer service lines. It is, thus, difficult to determine where the problems
exist.
Among the most striking findings presented in this chartbook is the overwhelming portion sixty
percent of Medicaid enrollees who reported their health status as "fair" or "poor." While Medicaid
is known to be a program that covers many chronically ill Floridians, it is also a program that covers
low-income families, refugees, and others. It is sobering to consider that the majority of adult
enrollees consider their health to be so poor. Two groups of enrollees, the MPN: PhyTrust group
and the MediPass No Choice group, had the "best" health ratings, with a larger portion of enrollees
reporting "excellent" or "very good" health and a smaller portion of enrollees reporting "fair" or "poor"
health. The Medicaid HMO group also seemed to have better health ratings than the other groups,
though a statistical comparison with other groups is outside the scope of this report.
Another striking finding is that a large portion of Medicaid enrollees (44%) consider themselves to
be in "fair" or "poor" mental health, and 45% of those surveyed scored within the "moderate" to
"severe" depression range on a depression screener. Among the program components, the
MediPass Choice group (which is made up of enrollees who reside in mostly urban counties that
offer a choice of care arrangements) had the largest portion of respondents in the "moderate" to
"severe" depression range. Mental health conditions, while more difficult to detect than some
physical conditions, can be equally debilitating and can affect quality of life significantly. Patients
who are depressed may not feel capable of caring for themselves and performing health-related or










other tasks as necessary.
Several indicators of quality of patient experience were compared by race and ethnicity of
respondent. For most indicators, there were no statistically significant differences in the experiences
of enrollees by racial or ethnic group. However, for the indicator measuring the patient's perception
that the doctor "showed respect for what the patient said," significant differences were found. A
larger portion of Hispanic enrollees, compared with non-Hispanics, reported that their doctor
"usually" or "always" showed respect for what they said. While this difference across groups is
statistically significant, it is, however, too small to have any practical importance. Thus, it appears
that, across all racial and ethnic groups, patients are equally likely to report favorable health care
experiences.
Enrollee ratings of physical health status also do not appear to be influenced by their race or
ethnicity. However, marginally statistically significant differences were found in how the various
racial and ethnic groups described their mental health status. Over 50% of Hispanic enrollees said
their mental health was "fair" or "poor" compared to about 38% of whites and 41% of blacks. One
possible explanation for the difference could be due to cultural dissimilarities in the interpretation of
the question.









Introduction












Most Medicaid recipients are required to obtain services through managed care. Those who are
dual-enrolled in Medicare or who reside in a nursing facility are exempt from this requirement, and,
thus, obtain care through the Medicaid providers of their choice on a fee-for-service (FFS) basis.
Among the managed care arrangements available to adult Medicaid enrollees are the following:
Medicaid Health Maintenance Organizations, or HMOs
The Medicaid Provider Access System, or MediPass
Minority Physician Networks or MPNs
The Provider Service Network or PSN
Although each program offers substantially similar benefits packages to the enrollee, their
management and administrative structure differs. Availability also differs, with enrollees in some
counties having no choice but the MediPass program, while those in other counties have a choice
from among up to 8 Medicaid HMOs, the MediPass program, the MPN, and the PSN. Counties
offering only MediPass are generally rural. These "No Choice" counties are expected to have worse
access to care compared with the more urban "Choice" counties. The table that follows give adult
enrollment among the various care arrangements, and the accompanying chart shows the
percentage of total adult enrollment made up by each arrangement.
A brief summary of each program's structure, availability, and enrollment is given later in this
section.















MediPass
Choice
14% MediPass
No Choice 4%
MPN:
NetPass 2%
Medicaid FFS MPN:

57% PhyTrust 1%

PSN 1%
Adult Enrollment
alo Jan. 2005


HMO 198,252
Fee for Service 545,816
MediPass Choice 137,392
MediPass No Choice 42,623
MPN: NetPass 16,511
MPN: PhyTrust 13,784
PSN 7,079
Source: Medicaid Administrative Data for January 2005


Medicaid HMO
21%


Adult Enrollment in Medicaid Managed Care

Organizations and Fee-for-Service Plans










Medicaid HMOs

The Agency for Health Care Administration (AHCA) has contracted with Health Maintenance
Organizations (HMOs) throughout the state to provide Medicaid services to a defined population of
enrolled Medicaid recipients. Medicaid HMOs are prepaid a fixed monthly rate (a capitation rate) per


member in each of the various eligibility categories, to
each member during the month.
As of January, 2005, there were 12 Medicaid HMOs
operating in the state, with a total adult (age 21+
years old) enrollment of roughly 200,000 persons.
Medicaid HMOs are available in 33 of the 67 Florida
counties. As a general rule, HMOs are offered in
more urban counties, and, in populous counties like
Miami-Dade, Broward, Palm Beach, Hillsborough,
Pinellas, and Orange, four or more HMO options are
available to enrollees. Counties without an HMO are
predominately rural. It is expected that individuals in
these 'No Choice' counties have a more difficult time
accessing care. The table to the right gives the total
adult enrollment, as of January, 2005, for each
HMO. It is worthy of note that 3 plans, Amerigroup,
Healthease, and Staywell, make up 71% of adult
Medicaid HMO enrollment.


provide all of the covered services required by

Market
Total Adult Share of
Plan Name
Enrollment HMO
Members
Amerigroup 40,345 20.4%
Buena Vista 6,864 3.5%
Citrus Health Care 2,259 1.1%
Healthease 58,144 29.3%
Healthy Palm Beaches 521 0.3%
Humana Family 13,865 7.0%
JMH Health Plan 4,019 2.0%
Preferred Medical Plan 4,650 2.3%
Staywell 42,521 21.4%
United ElderCare 2,996 1.5%
United Healthcare Plan 18,805 9.5%
VISTA HealthPlan of S. FL 3,263 1.6%
TOTAL 198,252 100.0%
Source: Medicaid Administrative Data for January 2005


The maps on the following pages show HMO availability by county, and enrollment by county.

Large portions of this section of the chartbook are taken directly from the Florida Medicaid Summary of Services, FY 2004-2005.






Numbe. ri of Medicaid HM~ [ perati n T in Each Foida Coun.~flt1y


Source: AHCA Managed Health Care Website, January 2005


WI No Medicaid HMOs
Ii 1
2
3
hII1 4
5 or more







Number of Adult Medicai HMO E nrolee by County**~i


*Adults defined as aged 21 years or older.
**Medicaid data show some HMO enrollees residing in counties that do not offer Medicaid HMOs. These enrollment figures
are anomalies and are not shown on this map. In most cases, the number of anomalous enrollees is less than 100.
Source: AHCA Administrative Data for January 2005


I I No Medicaid HMOs
ED 1-1,000 enrollees
1,001-10,000 enrollees
10,001+ enrollees


7V


rA








Medi[ a I [a1 [ia re 1 ArraT [gemnts Icniu [e


Medicaid HMOs, continued
Enrollment in any particular Medicaid HMO is specific to certain eligibility categories, counties, and
zip codes within counties. The following Medicaid recipients are not eligible to enroll in Medicaid
HMOS:
S Recipients who reside in an intermediate care facility for the developmentally disabled,
nursing facility, state mental hospital, or state-operated residential program;
S Recipients who are under the age of 21 and are enrolled in Children's Medical Services
or attend a prescribed pediatric extended care center;
S Recipients who receive hospice;
S Recipients who are enrolled in a Medicare or private HMO or other creditable health care
insurance such as TRICARE; and,
S Recipients who are only eligible for limited Medicaid under such programs as the Family
Planning waiver, Medically Needy or Qualified Medicare Beneficiary groups.







Large portions of this section of the chartbook are taken directly from the Florida Medicaid Summary of Services, FY 2004-2005.











MediPass
MediPass is a primary care case management program that is available in all 67 Florida counties.
MediPass primary care providers are responsible for providing or arranging for the recipient's
primary care and for referring the recipient for other necessary medical services on a 24-hour basis.
MediPass providers are paid a $3 patient management fee each month for each eligible person
who selects him or her as a primary care provider, plus Medicaid reimbursement for services that
are rendered.
Adult enrollment in MediPass exceeds 180,000 adult beneficiaries statewide. Of this 180,000,
roughly 137,000 are residents of a county that offers MediPass as well as one or more other
managed care options (e.g., Medicaid HMOs, MPNs, or PSN). The remaining 43,000 recipients
reside in one of the 34 Florida counties in which MediPass is the only managed care arrangement
offered. These "no choice" counties tend to be more rural when compared with the "choice"
counties.











Large portions of this section of the chartbook are taken directly from the Florida Medicaid Summary of Services, FY 2004-2005.











Minority Physician Networks or MPNs
The Minority Physician Network (MPN) program contracts with physician-owned organizations
consisting largely of providers belonging to racial and ethnic minority groups. The program was
initiated through contracts with two such organizations in Miami-Dade and Broward counties;
NetPass and PhyTrust. The networks are made up of primary care providers (PCPs) who are
responsible for managing care for MediPass beneficiaries.
Each of the MPN organizations has invested in computer systems to track and analyze beneficiary
utilization data. These computer systems enable the MPNs to distribute to their PCPs detailed and
structured utilization and provider data in the form of periodic performance reports.
Payments to the MPN organizations include a $3.00 per member per month management fee and
fee-for-service reimbursement for medical services. Since its inception, the MPN pilot project has
grown and spread to Pasco, Pinellas, Hardee, Highlands, Hillsborough, Manatee, and Polk counties.
In Miami-Dade, Broward, and Palm Beach counties, total MPN enrollment reached one-quarter of
total MediPass enrollment within two years of inception.








Large portions of this section of the chartbook are taken directly from the Florida Medicaid Summary of Services, FY 2004-2005.










The Provider Service Networks or PSN
A Provider Service Network (PSN) is an integrated health care delivery system owned and operated
by Florida hospitals and physician groups. The PSN is a Medicaid managed care option for Medicaid
recipients in Miami-Dade and Broward counties, and its adult enrollment exceeds 7,000. The South
Florida Community Care Network (SFCCN) PSN is composed of the Public Health Trust of Miami-
Dade County (PHT), the Memorial Healthcare System (MHS), and the North Broward Hospital District
(NBHD). SFCCN enrollees receive the majority of their health care through the PSN.
Out of network care provided to PSN enrollees (for PSN-managed services) must be authorized by
and claims must be submitted to the PSN in order for the claims to be paid by the Medicaid fiscal
agent. All Medicaid covered services are available to PSN enrollees. However, the SFCCN does not
manage community behavioral health, targeted case management, hospice, nursing facility, dental,
transportation, early intervention, medical foster care, prescribed pediatric extended care, school
based or waiver services.

The following categories of recipients are eligible to enroll in a PSN:

* Low Income Families and Children
* Sixth Omnibus Budget Reconciliation Act (SOBRA) children
* Children in Foster Care
* Children in Subsidized Adoptions
* Supplemental Security Income (SSI) recipients who do not receive Medicare


Large portions of this section of the chartbook are taken directly from the Florida Medicaid Summary of Services, FY 2004-2005.










Medicaid eligibility is a complex system that includes many categories of coverage. Eligibility categories
vary in terms of income criteria, health criteria, age limits, benefits offered, and other criteria. To
summarize, there are three basic groups who are eligible for Medicaid:
*SSI or Supplemental Security Income recipients,
*Children and families, and,
*Aged, blind and disabled people, including people needing institutional care.
The following chart shows adult Medicaid enrollment by eligibility category.
Eligibility for Supplemental Security Income, or SSI, is determined by the Social Security Administration.
All SSI recipients residing in Florida are automatically entitled to Florida Medicaid with full benefits. To
be eligible for an SSI check, an individual must be age 65 or older or, if under age 65, must be totally
and permanently disabled, and meet the SSI income and asset limits. Approximately 44% of Medicaid
adult enrollment is made up of SSI eligibles.
There are 5 categories of eligibility for children and families that offer full benefits. By far the largest
category, in terms of the number of enrollees served, is the TANF-related group, which accounts for
18% of adult Medicaid enrollment. This group includes low income families, including single-parent
families and families with a disabled or unemployed parent. Other full benefits categories include MEDS
(Medicaid Expansion Designated by SOBRA); Foster Care, Adoption Subsidy and Emergency Shelter;
Public Medical Assistance (PMA), and Mary Brogan Breast and Cervical Cancer Program.
Medicaid programs with full benefits for aged and disabled persons who are not otherwise eligible for
SSI include MEDS-AD (Medicaid for the Aged and Disabled), the Refugee Program, ICP (Institutional
Care Program), Hospice, and HCBS (Home and Community Based Services).
Large portions of this section of the chartbook are taken directly from the Florida Medicaid Summary of Services.






Adul Me[ica~r~T id~ En .rollmet by~ Eigibility Category, 20051.


Medicaid Overall

Medicaid HMO

Medicaid FFS

MediPass Choice

MediPass No Choice

MPN: NetPass

MPN: PhyTrust

PSN


0%


20%


4 *** 3.
39..1
)7/o


51.9
S' S
5 .


40%


18.3%


37.9


44.0%


U:' 27.6%

42.5%


60%


33.4% I

38.9% 1

29.6% I
I8
80%


Source: Medicaid administrative data for January 2005


ESSI
TANF
m Other


-

197
193


100%


^21.3%








Methods











The Medicaid HMO data presented in this chartbook were gathered separately from the data for the
other care arrangements. The State Center for Health Statistics gathered these data as part of its HMO
Report Card project, and generously shared it with the authors of this report. Detailed information
concerning sampling procedures and response rates for the HMO surveys can be found in the AHCA
publication, titled, Choosing a Quality Health Plan: Florida HMO Report.
The Medicaid HMO surveys were conducted using a different sampling frame, and different versions of
the CAHPS questionnaire, and different fielding methodologies. As a result, it is not possible to make
statistical comparisons between the reports from the HMO population and the other populations. The
Medicaid HMO results are presented here for reference purposes, but statements about statistically
significant differences between the HMOs and the other programs are not made.
Data for some measures were not collected for the HMO group because a different version of the
CAHPS questionnaire was used for those surveys. The HMO questionnaire consisted of the CAHPS
core questions only, while the questionnaire for the other program components included CAHPS
supplemental questions, as well as other non-CAHPS instruments, such as a general health status
measure and a depression screener.
In terms of sampling, it should be noted that two Medicaid HMOs, Citrus Health Care and Healthy Palm
Beaches, were not surveyed because they enroll relatively few Medicaid beneficiaries. Together, they
represent 1.5% of the total adult HMO enrollment in Medicaid.










Most data for this chartbook were collected by means of a telephone survey of enrollees, conducted
in the Spring of 2005. For all but the HMO surveys, which were administered by AHCA separately,
the survey instrument used was made up of three standardized questionnaires: The Consumer
Assessment of Health Plans Survey (CAHPS) version 3.0, the SF-12 version 2, and the PHQ-9.
Complete versions of the survey instruments can be found in the technical appendix to this document.
The CAHPS version 3.0 is a family of standardized survey instruments, used widely in the health care
industry to assess enrollee satisfaction with health plans. The CAHPS includes questions about
enrollees' experiences with primary care, specialty care, other types of care and health plan
administration. Demographics and health status measures are also included in the CAHPS.
The CAHPS survey used for all but the HMO surveys includes the Adult Medicaid "Core"
questionnaire, as well as the Supplemental Questions related to chronic conditions, dental care,
claims management, prescription medicine, transportation, special health services, and smoking
cessation.
CAHPS surveys are used nationwide in evaluations of Medicaid, Medicare, SCHIP and commercial
plans. The National CAHPS Benchmarking Database, which is a project funded by the US Agency
for Healthcare Research and Quality, publishes national "average" or benchmark scores for each of
the types of plans.
The SF-12 is a 12-item health status measure that is used widely in studies conducted around the
world. The SF-12 includes items measuring both physical and mental health.
The PHQ-9 is a 10-item screening tool for depression.











Concurrent, random samples were drawn from among enrollees in FFS, MediPass, the MPNs, and the
PSN. The samples included adults (age 21+) who, at the time the sample was extracted, had been
enrolled in their current care arrangement for at least 6 consecutive months. The MediPass sample
was further stratified according to whether the enrollees resided in a county which offered other
managed care options (the MediPass "Choice" group) or in a county which did not offer other
managed care options (the MediPass "No Choice" group). The MPN group was also stratified
according to whether enrollees were served by NetPass or PhyTrust.
Outcome rates for all surveys were comparable to other surveys among Medicaid populations in
Florida. See the technical appendix (under separate cover) for more detail.


Sampling and Outcome Rates










Weighting
Survey results for the Medicaid HMO group were statistically weighted to reflect the actual distribution
of individual HMO enrollment in Florida Medicaid. The reports of each HMO's respondents were
weighted according to the actual market share that particular HMO occupied within the Medicaid
program as of January, 2005. The weights were applied in order to properly reflect the relative sizes of
each HMO; companies with large enrollments should have a larger "impact" on results than those with
smaller enrollments.
The Medicaid "Overall" figures reported here are also weighted to reflect the actual distribution of
enrollees in the various care arrangements. The actual adult enrollment in each program as of
January, 2005 was used to calculate these weights. Again, these weights were used so that the
Medicaid "overall" figure would properly represent the makeup of the Medicaid adult population.
Because the FFS group represented 57% of adult Medicaid enrollment, this group's responses were
given more "weight" than those of other programs, such as the PSN, for example, which represents
less than 1% of total Medicaid adult enrollment. The reader should bear this in mind when reviewing
the Medicaid overall figures, since any effect of the PSN or MPNs on this figure will be small.

Confidence Intervals
A confidence interval is perhaps most familiar to non scientists as the plus-or-minus figure usually
reported in opinion poll results. Confidence intervals remind the reader that, although a single figure
may be presented (e.g., 71% chose response category "A"), the actual figure for the entire population,
including those who were not surveyed, may not be exactly that figure, but will fall within a range of
figures below and above the given value. The confidence interval for survey results given here will fall
within a range of plus or minus 5% of the given value.









Describing the Populations











Demographics












Nearly 71% of enrollees surveyed were female, while 29% were male. This is similar to the actual
gender distribution in Medicaid, in which 68% are female and 32% are male*. There were no significant
differences between the seven Medicaid programs in terms of gender breakdown.

Medicaid programs generally include a larger portion of women than men due to specific eligibility
criteria. Additionally, special coverage is provided for low-income women who are pregnant, and
women who are uninsured and have been diagnosed with breast or cervical cancer.

*Source: Agency for Health Care Administration, Frequency based on January 2005 data


Medicaid Medicaid
Gender
Gender Overall HMO Medicaid MediPass MediPass MPN: MPN:
(weighted) (weighted) FFS Choice No Choice NetPass PhyTrust PSN
Male 29.1% 23.1% 31.8% 26.2% 28.6% 30.1% 29.4% 31.8%
Female 70.9% 76.9% 68.2% 73.8% 71.4% 70.0% 70.6% 68.2%


Reflects distribution among survey respondents


Sources: 1.
2.


Medicaid Managed Care Surveys, FY 2005 and Medicaid Fee-for-Service Surveys, FY2005, Florida Center for Medicaid & the Uninsured.
Medicaid HMO Surveys, FY2005, State Center for Health Statistics







Gede of Enole Surveyed- -I


I Females


Medicaid Overall

Medicaid HMO

Medicaid FFS

MediPass Choice

MediPass No Choice

MPN: NetPass

MPN: PhyTrust

PSN


I Males


(II ". '
g *e '.








I *U 6 '
68.2% 3 1.8






*: S O
73.% 2.2

71.4% 28.6


I I I I I I

0% 20% 40% 60% 80% 100%

Reflects distribution among survey respondents
Sources: 1. Medicaid Managed Care Surveys, FY 2005 and Medicaid Fee-for-Service Surveys, FY2005, Florida Center for Medicaid & the Uninsured.
2. Medicaid HMO Surveys, FY2005, State Center for Health Statistics












Although the Medicaid program covers enrollees of all ages, including children, adolescents, and young
adults, this report focuses on the adult population, aged 21 and older. The overall sample was made
up of roughly 18% aged 21 to 34 years, 42% aged 35 to 64 years, and 40% aged 65 years or older.
This distribution, when compared with the actual distribution in Medicaid, is slightly skewed towards
older enrollees.

Among the programs, distributions were significantly different. The age distribution in the FFS
population stands out, with the program's enrollment being skewed significantly toward the older
groups. Fifty-eight percent of FFS enrollees were aged 65 or older, while 35% were aged 35-64, and
only 7% were aged 21-34. This distribution is not unexpected, considering that FFS enrollment
includes a large portion of Medicare-Medicaid dual eligibles and persons residing in a nursing facility.


Reflects distribution among survey respondents


Sources: 1.
2.


Medicaid Managed Care Surveys, FY 2005 and Medicaid Fee-for-Service Surveys, FY2005, Florida Center for Medicaid & the Uninsured.
Medicaid HMO Surveys, FY2005, State Center for Health Statistics


Medicaid
Age Distribution Overall HMO MediPass MediPass MPN: MPN:
(weighted) (weighted) FFS Choice No Choice NetPass PhyTrust PSN
21-34 years 18.1% 42.6% 7.0% 20.5% 31.5% 28.1% 34.6% 13.7%
35-64 years 42.4% 44.6% 34.8% 64.2% 61.6% 54.8% 52.8% 66.2%

65 years or older 39.5% 12.7% 58.2% 15.3% 6.9% 17.1% 12.6% 20.1%






Age of En olee Su ve e I


1 18-34 years old


35-64 years old 1 65 years or older


Medicaid Overall

Medicaid HMO

Medicaid FFS

MediPass Choice
MediPass No Choice


42.4%


-95%


--I


44.6%


34.8%


1 58.2%1


64.2%


1I


61.6%


MPN: NetPass

MPN: PhyTrust

PSN

0%


Sources: 1.
2.


Reflects distribution among survey respondents
Medicaid Managed Care Surveys, FY 2005 and Medicaid Fee-for-Service Surveys, FY2005, Florida Center for Medicaid & the Uninsured.
Medicaid HMO Surveys, FY2005, State Center for Health Statistics


54.8%


52.8%


66.2%


20%


40%


60%


80%


100%


-


17.1%


I^^











The educational attainment of Medicaid enrollees surveyed fell well-short of the state average.
Among Medicaid enrollees surveyed, roughly one-quarter had attained a level of education beyond
high school, while 32% had graduated high school or obtained a GED as their highest level of
educational attainment. Approximately 43% of those surveyed reported that they did not graduate
high school or obtain a GED. These figures are in stark contrast to that of the state population as a
whole. The US Census Bureau estimates that 79.9% of the Florida population aged 25 or older has
attained a level of education at or above high school graduation,1 while survey data, when adjusted
to compensate for the age category difference, show that only 59% of Medicaid enrollees aged 25
or older have graduated high school.

No meaningful differences exist between the reports of enrollees in the various Medicaid care
arrangements.

1Source: US Census Bureau, http://quickfacts.census.gov


Medicaid Medicaid
Education Attained
Education Aained Overall HMO Medicaid MediPass MediPass MPN: MPN:
(weighted) (weighted) FFS Choice No Choice NetPass PhyTrust PSN
Did Not Graduate High School 42.9% 32.7% 46.3% 45.1% 40.5% 41.6% 44.3% 45.8%
High School Graduate, or GED 32.2% 38.3% 29.4% 31.8% 38.4% 37.2% 28.9% 34.4%
Beyond High School 25.0% 29.0% 24.3% 23.1% 21.2% 21.2% 26.8% 19.8%


Sources: 1.
2.


Reflects distribution among survey respondents
Medicaid Managed Care Surveys, FY 2005 and Medicaid Fee-for-Service Surveys, FY2005, Florida Center for Medicaid & the Uninsured.
Medicaid HMO Surveys, FY2005, State Center for Health Statistics







~Eduaion[al[ Atta1V'~1inm uI]ent of Enolees] Suvee [I~ ~LY


Percent Who Have Graduated High School or Obtained a GED:


Medicaid Overall

Medicaid HMO

Medicaid FFS

MediPass Choice

MediPass No Choice


MPN: NetPass

MPN: PhyTrust


57.2%


67.3%


-I


53.7%


54.9%

159.6%

158.4%


-i


155.7%

54.2%


PSN


0%


20%


40%


60%


Sources: 1.
2.


Reflects distribution among survey respondents
Medicaid Managed Care Surveys, FY 2005 and Medicaid Fee-for-Service Surveys, FY2005, Florida Center for Medicaid & the Uninsured.
Medicaid HMO Surveys, FY2005, State Center for Health Statistics


80%


100%















Survey data suggest that the Medicaid program is made up of a larger percentage of Hispanics than the Florida
population as a whole. Twenty-nine percent of Medicaid enrollees surveyed reported being of Hispanic ethnicity,
while 17% of Florida's population overall is Hispanic.1 Note, however, that Medicaid administrative data show
only 15% of Medicaid enrollees reporting Hispanic ethnicity. This disparity in ethnicity figures may be due to
differences in data collection methods. Survey data were collected in the manner utilized by the US Census
Bureau1, in which Hispanic ethnicity is considered separately from racial identity, while Medicaid data were
collected using a single race/ethnicity item in which "Hispanic" is one of 6 racial/ethnic categories. It is likely that
the Census Bureau's data collection method captures a higher percentage of Hispanics compared with the
method used by Medicaid because it does not force respondents to choose between recording their Hispanic
ethnicity and another racial identity. Also, Medicaid's race/ethnicity variable is known to be unreliable, due to a
large percentage of program enrollees coded into the non-specific "other" category, and a large percentage with
no code at all. It is important to note that there are limitations to any method of categorizing racial and ethnic
identity.
Significant differences were found between the portion of Hispanics in the various program components. The
MPN: NetPass group and PSN group had the highest portion of Hispanics, at 49% each, while MediPass No
Choice has the lowest portion, at 13%.
1Source: US Census Bureau, http://quickfacts.census.gov


Respondent of Hispanic or Medicaid
Latino Origin or Descent? Overall HMO MediPass MediPass MPN: MPN:
(weighted) (weighted) FFS Choice No Choice NetPass PhyTrust PSN
Yes 29.1% 28.6% 27.4% 39.9% 13.4% 49.3% 36.9% 48.7%
No 71.0% 71.4% 72.6% 60.1% 86.6% 50.7% 63.1% 51.3%
Reflects distribution among survey respondents
Sources: 1. Medicaid Managed Care Surveys, FY 2005 and Medicaid Fee-for-Service Surveys, FY2005, Florida Center for Medicaid & the Uninsured.
2. Medicaid HMO Surveys, FY2005, State Center for Health Statistics










Percent reporting Hispanic or Latino Origin or Descent:

Medicaid Overall 29.1%

Medicaid HMO 28.6%

Medicaid FFS 27.4%

MediPass Choice 39.9%

MediPass No Choice 13.4%

MPN: NetPass 49.3%

MPN: PhyTrust 36.9%

PSN 48.7%

0% 20% 40% 60% 80% 100%
Reflects distribution among survey respondents
Sources: 1. Medicaid Managed Care Surveys, FY 2005 and Medicaid Fee-for-Service Surveys, FY2005, Florida Center for Medicaid & the Uninsured.
2. Medicaid HMO Surveys, FY2005, State Center for Health Statistics













More than three-quarters of the Medicaid population indicated that the primary language spoken in
their homes was English, while 23% indicated it was Spanish, and 2% indicated it was some other
language. This finding is consistent with the US Census Bureau's report that 24% of Florida
residents aged 5 and over speak some language other than English at home.1

Significant differences were found between the reports of the various programs' enrollees. The
percentage of persons primarily speaking a language other than English in the home ranged from a
high of 45% in the PSN group to a low of 9% in the MediPass No Choice group.

1Source: US Census Bureau, American Fact Finder, R1601, from the 2004 American Community Survey



Primary Language Medicaid Medicaid
Spoken in the Home Overall HMO Medicaid MediPass MediPass MPN: MPN:
(weighted) (weighted) FFS Choice No Choice NetPass PhyTrust PSN
English 75.6% 77.3% 76.1% 67.7% 91.5% 57.2% 70.8% 54.7%
Spanish 22.5% 19.4% 22.6% 30.2% 7.2% 40.4% 26.5% 41.8%
Other 1.9% 3.2% 1.3% 2.1% 1.3% 2.4% 2.7% 3.6%


Reflects distribution among survey respondents


Sources: 1.
2.


Medicaid Managed Care Surveys, FY 2005 and Medicaid Fee-for-Service Surveys, FY2005, Florida Center for Medicaid & the Uninsured.
Medicaid HMO Surveys, FY2005, State Center for Health Statistics








Percent Reporting that Spanish is the Primary Language Spoken in the Home:


Medicaid Overall

Medicaid HMO

Medicaid FFS

MediPass Choice

MediPass No Choice

MPN: NetPass

MPN: PhyTrust

PSN


-I


122.5%

19.4%

122.6%

- 30.2%


4I


7.2%


40.4%


26.5%


41.8%


0% 20% 40% 60% 80% 100%
Reflects distribution among survey respondents
Sources: 1. Medicaid Managed Care Surveys, FY 2005 and Medicaid Fee-for-Service Surveys, FY2005, Florida Center for Medicaid & the Uninsured.
2. Medicaid HMO Surveys, FY2005, State Center for Health Statistics
36


-I













Survey data suggest that the Medicaid program is made up of a smaller percentage of whites than the
Florida population as a whole. Sixty percent of Medicaid enrollees surveyed reported being white (and
not multiracial), compared with 78% in the Florida population as a whole.* Note that these figures
include persons of Hispanic ethnicity. (The questionnaire included separate items for Hispanic ethnicity
and race, so respondents could indicate, for example, being Hispanic and white.) When Hispanic
respondents are excluded, roughly 41% of survey respondents reported being white and non-Hispanic.
This figure is comparable to that found in Medicaid administrative data, in which 43% of Medicaid-
enrolled adults were white.

Significant differences were found between the programs in terms of the portion of whites enrolled. The
MediPass No Choice group was composed of the large percentage of whites, at 56%, while the PSN
was composed of the smallest percentage of whites, at 4%.

1Source: US Census Bureau, http://quickfacts.census.gov


Medicaid Medicaid
Racial Categories Overall HMO Medicaid MediPass MediPass MPN: MPN:
(weighted) (weighted) FFS Choice No Choice NetPass PhyTrust PSN
Hispanic 27.7% 28.0% 25.8% 37.8% 12.9% 48.1% 35.3% 46.9%
White, non-Hispanic 41.3% 30.5% 46.5% 33.4% 55.6% 31.1% 35.6% 4.1%
Black, non-Hispanic 24.7% 35.1% 21.5% 22.0% 23.6% 16.0% 24.6% 44.7%
Other race, non-Hispanic 2.8% 4.0% 2.1% 3.9% 3.4% 2.9% 2.7% 2.2%
Multiracial, non-Hispanic 3.6% 2.4% 4.1% 2.9% 4.5% 1.9% 1.9% 2.2%
Reflects distribution among survey respondents
Sources: 1. Medicaid Managed Care Surveys, FY 2005 and Medicaid Fee-for-Service Surveys, FY2005, Florida Center for Medicaid & the Uninsured.
2. Medicaid HMO Surveys, FY2005, State Center for Health Statistics











Percent Reporting Their Race as White (and not multiracial) and non-Hispanic:


Medicaid Overall

Medicaid HMO

Medicaid FFS

MediPass Choice

MediPass No Choice

MPN: NetPass

MPN: PhyTrust

PSN 4.1%

0%


41.3%


30.5%


46.5%


33.4%


55.6%


31.1%


35.6%


20%


40%


60%


80%


Sources: 1.
2.


Reflects distribution among survey respondents
Medicaid Managed Care Surveys, FY 2005 and Medicaid Fee-for-Service Surveys, FY2005, Florida Center for Medicaid & the Uninsured.
Medicaid HMO Surveys, FY2005, State Center for Health Statistics


100%













Survey data suggest that the Medicaid program is made up of a larger percentage of blacks than the
Florida population as a whole. Twenty-six percent of Medicaid enrollees surveyed reported being black
(and not multiracial), compared with 15% in the Florida population as a whole. Note that these figures
include persons of Hispanic ethnicity. (The questionnaire included separate items for Hispanic ethnicity
and race, so respondents could indicate, for example, being Hispanic and black.) When Hispanic
respondents are excluded, roughly 25% of survey respondents reported being black and non-Hispanic.
This figure is comparable to that found in Medicaid administrative data, in which 24.8% of Medicaid-
enrolled adults were black.

Significant differences were found between the programs in terms of the portion of blacks enrolled. The
PSN was composed of the largest percentage of Blacks, at 45%, while the MPN: NetPass group was
composed of the smallest percentage of Blacks, at 16%.


1Source: US Census Bureau, http://quickfacts.census.gov

Medicaid Medicaid
Racial Category Overall HMO Medicaid MediPass MediPass MPN: MPN:
(weighted) (weighted) FFS Choice No Choice NetPass PhyTrust PSN
Hispanic 27.7% 28.0% 25.8% 37.8% 12.9% 48.1% 35.3% 46.9%
White, non-Hispanic 41.3% 30.5% 46.5% 33.4% 55.6% 31.1% 35.6% 4.1%
Black, non-Hispanic 24.7% 35.1% 21.5% 22.0% 23.6% 16.0% 24.6% 44.7%
Other race, non-Hispanic 2.8% 4.0% 2.1% 3.9% 3.4% 2.9% 2.7% 2.2%
Multiracial, non-Hispanic 3.6% 2.4% 4.1% 2.9% 4.5% 1.9% 1.9% 2.2%
Reflects distribution among survey respondents
Sources: 1. Medicaid Managed Care Surveys, FY 2005 and Medicaid Fee-for-Service Surveys, FY2005, Florida Center for Medicaid & the Uninsured.
2. Medicaid HMO Surveys, FY2005, State Center for Health Statistics











Percent Reporting Their Race as Black (and not multiracial) and non-Hispanic:

Medicaid Overall 24.7%

Medicaid HMO 35.1%

Medicaid FFS 21.5%

MediPass Choice 22.0%

MediPass No Choice 23.6%

MPN: NetPass 16.0%

MPN: PhyTrust 24.6%

PSN 44.7%

0% 20% 40% 60% 80% 100%
Reflects distribution among survey respondents
Sources: 1. Medicaid Managed Care Surveys, FY 2005 and Medicaid Fee-for-Service Surveys, FY2005, Florida Center for Medicaid & the Uninsured.
2. Medicaid HMO Surveys, FY2005, State Center for Health Statistics
40













Survey respondents were asked how long they had been continuously enrolled in Medicaid. Overall,
roughly 47% reported having been enrolled for 5 or more years, 28% reported being enrolled between 2
and 5 years, 15% reported 1 to 2 years, and 10% reported having been enrolled for less than 1 year.

There were marked differences among the Medicaid program components in terms of enrollment spans.
(Note that this measure refers to length of enrollment in Medicaid overall, not length of enrollment in a
particular program component.) Although statistical comparisons of the HMO group to the other groups
is not possible, the results from the HMO group appear to be markedly different from the other groups.
Medicaid HMO enrollees appeared to report shorter enrollment spans than those for any other program
component. Eighteen percent of HMO enrollees reported being enrolled for less than 1 year, compared
with the overall Medicaid figure of 10%. More than 70% of HMO enrollees reported being enrolled
between 1 and 5 years, compared with 43% for the Medicaid overall. Twelve percent of HMO enrollees
reported being enrolled for 5 or more years, while the overall Medicaid figure was 47%.

It is important to note that these figures are based on self report. Respondent recall for issues related to
discreet time periods is imperfect. This measure reflects respondent perception of continuous
enrollment.
Medicaid Medicaid
Measure Overall HMO Medicaid MediPass MediPass MPN: MPN:
(weighted) (weighted) FFS Choice No Choice NetPass PhyTrust PSN
Less than 1 year 10.0% 17.8% 8.3% 6.1% 6.1% 8.2% 10.8% 5.5%
At least 1 yr, but less than 5 yrs 43.3% 70.4% 32.7% 42.3% 46.4% 54.8% 45.3% 47.1%
5 or more years 46.7% 11.8% 59.0% 51.7% 47.5% 36.9% 43.9% 47.4%
Reflects distribution among survey respondents
Sources: 1. Medicaid Managed Care Surveys, FY 2005 and Medicaid Fee-for-Service Surveys, FY2005, Florida Center for Medicaid & the Uninsured.
2. Medicaid HMO Surveys, FY2005, State Center for Health Statistics







C t u oIs l [ U I mile] I Im Ian L'Me[ ic [* d [I


Less than one year

Medicaid Overall

Medicaid HMO

Medicaid FFS

MediPass Choice

MediPass No Choice

MPN: NetPass

MPN: PhyTrust

PSN


* At least 1 year, less than 5 years




7.8









S.* .
8 .3 A2.
61 42.3%

6 .1 4 .


Five or more years

46.7%

11.8%

59.0%

51.7%

47.5%

36.9%

43.9%

47.4%


I I I I I I
0% 20% 40% 60% 80% 100%
Reflects distribution among survey respondents
Sources: 1. Medicaid Managed Care Surveys, FY 2005 and Medicaid Fee-for-Service Surveys, FY2005, Florida Center for Medicaid & the Uninsured.
2. Medicaid HMO Surveys, FY2005, State Center for Health Statistics
42











Health Status













Sixty percent of enrollees surveyed reported being in "fair" or "poor" health, while another 21% reported
being in "good" health, and 19% reported being in "very good" or "excellent" health. This finding is not
unexpected, as the Medicaid program provides coverage for a large portion of the aged and chronically
ill in the state; 52% of people with AIDS are covered by Medicaid and 66% of nursing home days are
covered by Medicaid.1

Significant variations exist between the reports of enrollees in the various Medicaid programs. While the
HMO enrollees appear to have the lowest portion of enrollees in the "fair or poor" category and the
highest portion in the "excellent or very good" category, these results cannot be statistically compared
with those of the other program components due to methodological considerations (see methodology
section for more details). The FFS, MediPass Choice, MPN: NetPass, and PSN groups had similar
figures, with 61-67% of enrollees in the "fair or poor" category. The MediPass No Choice and MPN:
PhyTrust groups had much lower portions of enrollees in this group, with only 54% in this category.
1Source: Presentation titled "Florida's Medicaid Program," by Deputy Secretary for Medicaid Thomas W. Arnold, 06-28-2005.



Medicaid
HMO MediPass MediPass MPN: MPN:
Self-Assessed Overall Health Overall H FFS PSN
(weighted) Choice No Choice NetPass PhyTrust
(weighted)
Excellent or Very Good 19.0% 29.6% 15.8% 12.9% 23.2% 19.2% 23.2% 11.7%
Good 21.1% 29.8% 17.9% 20.0% 23.0% 19.8% 22.6% 23.4%
Fair or Poor 59.9% 40.6% 66.3% 67.2% 53.8% 61.0% 54.2% 64.9%

Reflects distribution among survey respondents
Sources: 1. Medicaid Managed Care Surveys, FY 2005 and Medicaid Fee-for-Service Surveys, FY2005, Florida Center for Medicaid & the Uninsured.
2. Medicaid HMO Surveys, FY2005, State Center for Health Statistics








Percent describing their health as "fair" or "poor":


Medicaid Overall

Medicaid HMO

Medicaid FFS

MediPass Choice

MediPass No Choice


MPN: NetPass


MPN: PhyTrust

PSN

0%


S61.0%

54.2%


64.9%


20%


40%


60%


Sources: 1.
2.


Reflects distribution among survey respondents
Medicaid Managed Care Surveys, FY 2005 and Medicaid Fee-for-Service Surveys, FY2005, Florida Center for Medicaid & the Uninsured.
Medicaid HMO Surveys, FY2005, State Center for Health Statistics


59.9%


40.7%


66.3%

167.2%


53.8%


80%


100%


Sel-Asessd Halt Sttu













Among Medicaid beneficiaries, self-reported health status varies across racial and ethnic groups.
Almost 25% of Black, non-Hispanic enrollees reported their health as "excellent" or "very good". In
comparison, 16% of Hispanics rated their health as "excellent" or "very good". Sixty-one percent of
Hispanics said they were in "fair" or "poor" health compared to 51% of non-Hispanic, blacks. It is
possible that some of the difference in health status can be attributed to differing perceptions of health
and disease across racial and ethnic groups.


NOTE: Multiracial, non Hispanic and Other, non-Hispanic categories not reported because the sample size
to permit statistical inference.


Self-Assessed Overall Medicaid
Health Overall White, non Black, non
(weighted) Hispanic Hispanic Hispanic
Excellent or Very Good 12.0% 16.4% 17.5% 24.7%
Good 21.1% 22.8% 18.1% 24.0%
Fair or Poor 59.9% 60.7% 64.4% 51.3%


is too small


Reflects distribution among survey respondents


Sources: 1.
2.


Medicaid Managed Care Surveys, FY 2005 and Medicaid Fee-for-Service Surveys, FY2005, Florida Center for Medicaid & the Uninsured.
Medicaid HMO Surveys, FY2005, State Center for Health Statistics







S l- A ss s e H e lt St t s by R ac an Et n ct I


Percent describing their health as "fair" or "poor"


Black, non-
Hispanic



White, non-
Hispanic



Hispanic


0%
0%


51.3%


E 64.4%



60.7%


20%


40%


60%


Reflects distribution among survey respondents
Sources: 1. Medicaid Managed Care Surveys, FY 2005 and Medicaid Fee-for-Service Surveys, FY2005, Florida Center for Medicaid & the Uninsured.
2. Medicaid HMO Surveys, FY2005, State Center for Health Statistics


80%


100%














A large portion of Medicaid enrollees reported that their mental health was less than "good." Forty-four
percent of enrollees surveyed reported being in "fair" or "poor" mental health, while another 26%
reported being in "good" mental health, and 30% reported being in "very good" or "excellent" mental
health. The large number of enrollees reporting that they are in "fair" or "poor" mental health is a
concern. Mental health conditions can be more difficult to detect than physical conditions, and they can
be equally debilitating. The cost of treating such conditions is high (Currently, 16% of Florida Medicaid
prescription drug spending goes toward medications to treat mental and emotional health conditions.*),
but the cost of leaving them untreated may be higher. Mental and emotional health conditions can
manifest themselves physically or can exacerbate existing physical conditions, and those who are
suffering from mental or emotional conditions may not be able to work or function normally.**

The reports of the various Medicaid program components did not vary significantly on this measure.
*Source: Agency for Health Care Administration, Bureau of Medicaid Pharmacy Services
**Source: Mental Health: A Report of the Surgeon General, 1999


Medicaid Medicaid
Self assessment of overall
Self assessment of overall Overall HMO Medicaid MediPass MediPass MPN: MPN:
mental/emotional health lighted) (weighted) FFS Choice No Choice NetPass PhyTrust
(weighted) (weighted) FFS Choice No Choice NetPass PhyTrust PSN


Excellent or Very Good 30.0%/
Good 25.60/
Fair or Poor 44.4%/


30.9% 24.2% 32.4% 30.5% 33.1% 25.0%
25.9% 26.3% 23.3% 22.3% 21.4% 25.6%
43.3% 49.5% 44.3% 47.1% 45.5% 49.4%


HMO Enrollees, who were surveyed separately, were not asked this question Reflects distribution among survey respondents

rces: 1. Medicaid Managed Care Surveys, FY 2005 and Medicaid Fee-for-Service Surveys, FY2005, Florida Center for Medicaid & the Uninsured.
2. Medicaid HMO Surveys, FY2005, State Center for Health Statistics


Sou






S -A s s e s s e M e n t l Hh S I


Percent describing their mental health as "fair" or "poor":


Medicaid Overall

Medicaid HMO

Medicaid FFS

MediPass Choice

MediPass No Choice

MPN: NetPass

MPN: PhyTrust

PSN


Question Not Asked


144.4%


43.3%

149.5%
44.3%

S47.1%

145.5%
0 49.4%


0% 20% 40% 60% 80% 100%
Reflects distribution among survey respondents
Sources: 1. Medicaid Managed Care Surveys, FY 2005 and Medicaid Fee-for-Service Surveys, FY2005, Florida Center for Medicaid & the Uninsured.
2. Medicaid HMO Surveys, FY2005, State Center for Health Statistics
49














There is a statistically significant difference in self-reported mental health status across racial and
ethnic groups. Almost 60% of Hispanic enrollees said that their mental health was "fair" or "poor",
compared to about 38% of enrollees who are white, and 41% of black enrollees. A larger portion of
black enrollees, compared with the other racial and ethnic groups, reported that their mental health was
"excellent" or "very good".


NOTE: Multiracial, non Hispanic and Other, non-Hispanic categories not reported because the sample size is too small
to permit statistical inference


Medicaid
Self assessment of overall
Overall White, non. Black, non
mental/emotional health (weighted) Hispanic Hispanic Hispanic
Excellent or Very Good 30.0% 20.4% 32.6% 37.2%
Good 25.6% 21.7% 29.4% 22.1%
Fair or Poor 44.4% 57.9% 38.0% 40.7%


HMO Enrollees, who were surveyed separately, were not asked this question


Reflects distribution among survey respondents


Medicaid Managed Care Surveys, FY 2005 and Medicaid Fee-for-Service Surveys, FY2005, Florida Center for Medicaid & the Uninsured.
Medicaid HMO Surveys, FY2005, State Center for Health Statistics


Sources: 1.
2.







S e l f A s s s s e M e n t a H S t tiu s y Re a


Percent describing their mental health as "fair" or "poor":


Black, non-
Hispanic


40.7%


White, non-
Hispanic




Hispanic 57.9%



0% 20% 40% 60% 80% 100%
Does not include data from HMO enrollees Reflects distribution among survey respondents
Sources: 1. Medicaid Managed Care Surveys, FY 2005 and Medicaid Fee-for-Service Surveys, FY2005, Florida Center for Medicaid & the Uninsured.
2. Medicaid HMO Surveys, FY2005, State Center for Health Statistics














A striking number of Medicaid respondents scored in the range of moderate to severe depression on the
10-item depression screener administered as part of this survey. Overall, 45% of Medicaid respondents
were moderately to severely depressed, with 13% scoring in the "severe" range, 12% in the "moderately
severe" range, and 20% in the "moderate" range. Another 23% of enrollees were in the "mild"
depression range, and 20% were in the "minimal" depression range. Thirteen percent of respondents
showed no depression symptoms.

The reports of the various program components differed significantly, with the MediPass Choice group
being made up of the largest portion of respondents in the moderate to severe range, and the MPN:
PhyTrust group being made up of a smallest portion.

It is important to note that depression screeners alone cannot be used to diagnose depression.
However, the high percentage of respondents scoring in the moderately to severely depressed range is
cause for concern.

Medicaid Medicaid
Level of Depression Severity Overall HMO Medicaid MediPass MediPass MPN: MPN:
(weighted) (weighted) FFS Choice No Choice NetPass PhyTrust PSN


No depression symptoms (PHQ score 0) 12.6c
Minimal depression (PHQ-9 score 1-4) 19.8c
Mild depression (PHQ-9 score 5-9) 23.2c
Moderate depression (PHQ-9 score 10-14) 19.8c
Moderately severe (PHQ-9 score 15-19) 11.7c
Severe (PHQ-9 score 20-27) 13.0c


12.9% 10.7% 14.8% 16.5% 20.3% 10.8%
21.4% 14.0% 19.6% 18.2% 21.3% 16.8%
23.5% 23.1% 24.5% 20.3% 19.4% 24.5%
19.4% 20.1% 19.0% 14.8% 17.1% 20.6%
11.2% 14.3% 10.6% 13.8% 13.2% 13.6%
11.6% 17.9% 11.5% 16.5% 8.7% 13.6%


HMO Enrollees, who were surveyed separately, were not asked this question Reflects distribution among survey respondents
Sources: 1. Medicaid Managed Care Surveys, FY 2005 and Medicaid Fee-for-Service Surveys, FY2005, Florida Center for Medicaid & the Uninsured.
2. Medicaid HMO Surveys, FY2005, State Center for Health Statistics









Percent whose score on the depression screener indicated that they were
"Moderately" to "Severely" depressed:


Medicaid Overall

Medicaid HMO

Medicaid FFS

MediPass Choice

MediPass No Choice

MPN: NetPass

MPN: PhyTrust

PSN


44.5%


Question Not Asked


42.2%


52.3%


141.1%

E 45.0%

39.0%


47.9%


I I I I I I
0% 20% 40% 60% 80% 100%
Reflects distribution among survey respondents
Sources: 1. Medicaid Managed Care Surveys, FY 2005 and Medicaid Fee-for-Service Surveys, FY2005, Florida Center for Medicaid & the Uninsured.
2. Medicaid HMO Surveys, FY2005, State Center for Health Statistics
53













Medicaid enrollees were asked several detailed questions about their health status and about medical
conditions they may have. Seventy-eight percent of respondents reported that they had a health
condition that interferes with their ability to work, attend school, or manage day-to-day activities. Fifty-
eight percent of enrollees surveyed reported that their health limits them in doing moderate activities,
such as moving a table or pushing a vacuum cleaner. Fifty-three percent indicated that they had a
physical or medical condition that interferes with their independence, participation in the community, or
quality of life. Sixty-eight percent of respondents said they had a health condition that had lasted for 3
months or more.

Significant differences were found between the program components on all of these items. The FFS
and MediPass Choice groups had the highest percentages of people who reported needing assistance
and having significant health problems.


Medicaid Medicaid
Measure Overall HMO
(weighted) (weighted)
Have a physical or medical condition that
interferes with work, school, or daily activities 7

Health Limits Doing Moderate Activities 57.8%

Has a physical or medical condition that inteferes 52.5%
with independence or quality of life
Has any physical or medical conditions that has
lasted for at least 3 months (does not include 67.5%
pregnancy)


Medicaid MediPass MediPass MPN: MPN:
FFS Choice No Choice NetPass PhyTrust PSN
78.1% 79.7% 71.3% 69.3% 67.4% 77.9%

58.9% 62.0% 51.2% 49.9% 50.3% 59.8%

52.0% 59.0% 47.2% 49.5% 42.9% 49.4%


68.2% 68.9% 64.4% 57.1% 55.4% 60.6%


HMO Enrollees, who were surveyed separately, were not asked this question Reflects distribution among survey respondents
Sources: 1. Medicaid Managed Care Surveys, FY 2005 and Medicaid Fee-for-Service Surveys, FY2005, Florida Center for Medicaid & the Uninsured.
2. Medicaid HMO Surveys, FY2005, State Center for Health Statistics







H e [ lt h I C nIt io ns th at In t er f (e1 rI It h SA. I ty Iof L i f I


Among Medicaid enrollees surveyed, regardless of program/plan:


Has a Health Condition that Interferes
with Day-to-Day Life


Has Health Limits Doing Moderate
Activities


Has a Health Condition that Interferes
with Quality of Life


Has a Medical Condition that has Lasted
3 Months or Longer


77.6%


I 57.8%



52.5%


67.5%


20% 40% 60% 80% 100%


Does not include data from HMO Enrollees.
Sources: 1. Medicaid Managed Care Surveys, FY2005 and Medicaid Fee-for-Service Surveys,
2. Medicaid HMO Surveys, FY2005, State Center for Health Statistics


Reflects distribution among survey respondents
FY2005, Florida Center for Medicaid & the Uninsured.


0%















Medicaid enrollees were asked whether they needed assistance with personal care needs, such as
eating, dressing, or getting around the house. Seventeen percent of respondents indicated that they
needed help with such tasks. Respondents were also asked if they needed assistance with routine
needs, such as everyday household chores, doing necessary business, shopping, or getting around for
"other" purposes. Thirty-four percent of respondents indicated that they needed this type of assistance.

A significant difference between the program components was found for the item measuring help
needed with personal care. Eighteen percent of FFS enrollees reported needing this type of assistance,
compared with only 8% among the MediPass No Choice group. No significant difference was found on
the measure of help with routine needs.


Medicaid
Measure Overall
(weighted)
Needs help with personal care needs (e.g.,
17.0%
eating or dressing)
Needs help with routine needs (e.g,
33.5%household chores, shopping)
household chores, shopping)


HMO Enrollees, who were surveyed separately, were not asked this question


Sources: 1.
2.


Medicaid MediPass MediPass MPN: MPN:
FFS Choice No Choice NetPass PhyTrust PSN
18.2% 14.8% 8.4% 15.0% 13.5% 15.2%

33.9% 35.3% 26.9% 32.3% 29.1% 30.2%


Reflects distribution among survey respondents


Medicaid Managed Care Surveys, FY 2005 and Medicaid Fee-for-Service Surveys, FY2005, Florida Center for Medicaid & the Uninsured.
Medicaid HMO Surveys, FY2005, State Center for Health Statistics










Among Medicaid enrollees surveyed, regardless of program/plan:


Needs Assistance
with Routine Needs
(e.g., household 33.5%
chores or
shopping)



Needs Assistance
with Personal Care 17
17.0%
Needs (e.g., Eating
or Dressing)



0% 20% 40% 60% 80% 100%

Does not include data from HMO Enrollees. Reflects distribution among survey respondents
Sources: 1. Medicaid Managed Care Surveys, FY 2005 and Medicaid Fee-for-Service Surveys, FY2005, Florida Center for Medicaid & the Uninsured.
2. Medicaid HMO Surveys, FY2005, State Center for Health Statistics















Medicaid enrollees surveyed were asked if they had a physical or medical condition that interfered
with work, school, or their daily activities. Overall, 78% of respondents reported affirmatively.

Significant variations exist between the reports of enrollees in the various Medicaid programs. The
MediPass Choice group had the largest portion (80%) of respondents reporting that they had a
health condition that interfered with their daily lives, while the MPN: PhyTrust group had the
smallest portion, at 67%.


Have a physical or medical Medicaid Medicaid
condition that interferes with Overall HMO Medicaid MediPass MediPass MPN: MPN:
work, school, or daily activities (weighted) (weighted) FFS Choice No Choice NetPass PhyTrust PSN
Yes 77.60/ 78.1% 79.7% 71.3% 69.3% 67.4% 77.9%
No 22.49/o 21.9% 20.3% 28.7% 30.7% 32.6% 22.1%


HMO Enrollees, who were surveyed separately, were not asked this question


Reflects distribution among survey respondents


Medicaid Managed Care Surveys, FY2005 and Medicaid Fee-for-Service Surveys, FY2005, Florida Center for Medicaid & the Uninsured.
Medicaid HMO Surveys, FY2005, State Center for Health Statistics


Sources: 1.
2.










Percent reporting that they had a physical or medical condition that interferes with
work, school, or daily activities
-i


Medicaid Overall

Medicaid HMO

Medicaid FFS

MediPass Choice


I Question Not Asked


77.6%



78.1%

179.7%


MediPass No Choice 71.3%

MPN: NetPass 69.3%

MPN: PhyTrust 67.4%

PSN 77.9%

0% 20% 40% 60% 80% 100%
HMO Enrollees, who were surveyed separately, were not asked this question Reflects distribution among survey respondents
Sources: 1. Medicaid Managed Care Surveys, FY 2005 and Medicaid Fee-for-Service Surveys, FY2005, Florida Center for Medicaid & the Uninsured.
2. Medicaid HMO Surveys, FY2005, State Center for Health Statistics








Experiences with Care
and Satisfaction










Primary Care












A usual source of care is a physician, nurse, or other health professional who serves as the primary
health provider for an enrollee. Individuals who have a usual source of care, or a "personal doctor or
nurse," are more likely to receive preventive care than those who do not have a primary care provider.*
Thus, the percentage of enrollees who report having a usual source of care is an important indicator of
quality of care provided by a health program. Among Medicaid enrollees surveyed, 80% reported
having a personal doctor or nurse.
Among Medicaid programs, the FFS program had the highest percentage of beneficiaries reporting that
they had a personal doctor or nurse with 82% reporting thus. The PSN and MPN: PhyTrust had the
lowest percentage with a personal doctor or nurse, with figures of 71.4% and 71.9%, respectively.
*Source: Lambrew JM, DeFriese GH, Cary TS, Ricketts TC, Briddle AC, "The effects of having a regular doctor on access to primary
care," Medical Care, 1196, Feb; 34(2): 138-151


Do you have a Medicaid I Medicaid
personal doctor Overall O Id Medicaid MediPass MediPass No MPN: MPN: PSN
personal doctor or Overall HMO PSN
nurse? (weighted) (weighted) FFS Choice Choice NetPass PhyTrust
nurse? (weighted) (weighted)
Yes 79.7% 73.5% 82.3% 82.1% 72.8% 80.9% 71.9% 71.4%
No 20.4% 26.5%1 17.7% 17.9% 27.3% 19.1% 28.1% 28.6%


Reflects distribution among survey respondents


Sources: 1.
2.


Medicaid Managed Care Surveys, FY 2005 and Medicaid Fee-for-Service Surveys, FY2005, Florida Center for Medicaid & the Uninsured.
Medicaid HMO Surveys, FY2005, State Center for Health Statistics






Peso a Doto or Nurs I


Percent with a personal doctor or nurse:


Medicaid Overall

Medicaid HMO

Medicaid FFS

MediPass Choice

MediPass No Choice

MPN: NetPass


S79.7%

173.5%

S82.3%

U82.1%

72.8%

in80.9%


MPN: PhyTrust 71.9%

PSN 71.4%

0% 20% 40% 60% 80% 100%
Reflects distribution among survey respondents
Sources: 1. Medicaid Managed Care Surveys, FY 2005 and Medicaid Fee-for-Service Surveys, FY2005, Florida Center for Medicaid & the Uninsured.
2. Medicaid HMO Surveys, FY2005, State Center for Health Statistics
63











The term "Continuity of Care" refers to the extent to which enrollees are able to see a single health care
provider over a period of time. Measuring the continuity of care that enrollees receive is an important
step in describing the overall quality of care provided by any health insurance program. To this end,
subjects were asked how long they had been seeing the same "personal doctor or nurse" as their
primary care provider. The vast majority of Medicaid enrollees (85%) reported seeing the same
personal doctor or nurse for at least 1 year, and a substantial portion reported seeing that PCP for 5 or
more years.

The reports of the enrollees in the various care programs differed significantly in terms of length of time
seeing their personal doctor or nurse. The FFS and PSN groups have the largest portion of enrollees
who had been seeing their current PCPs for 5 or more years. Among these groups, 45-48% of
respondents reported seeing their PCPs for five or more years, while 38-39% had seen their provider for
1 to 5 years, and 14-15% had seen their provider for less than one year. The MPN: PhyTrust group had
the largest portion (24%) of enrollees who had been seeing their PCPs for less than one year.



Medicaid Medicaid
# of Months or years going Overall HMO Medicaid MediPass MediPass MPN: MPN:
to Personal Doctor or Nurse eight) (weighted) FFS Choice No Choice NetPass PhyTrust
(weighted) (weighted) FFS Choice No Choice NetPass PhyTrust PSN


Less than 1 year 14.8%
At least 1 year, less than 5 years 41.3%
5 years or more 43.9%


14.0% 15.9% 19.6% 15.6% 24.1% 15.4%
38.0% 54.6% 45.6% 56.4% 45.9% 39.4%
48.1% 29.5% 34.8% 28.0% 30.0% 45.1%


HMO Enrollees, who were surveyed separately, were not asked this question Reflects distribution among survey respondents

;s: 1. Medicaid Managed Care Surveys, FY 2005 and Medicaid Fee-for-Service Surveys, FY2005, Florida Center for Medicaid & the Uninsured.
2. Medicaid HMO Surveys, FY2005, State Center for Health Statistics


Source









Percent of Respondents Reporting that they had been Seeing their Personal Doctor
or Nurse for 1 Year or Longer:


Medicaid Overall

Medicaid HMO

Medicaid FFS

MediPass Choice

MediPass No Choice

MPN: NetPass

MPN: PhyTrust

PSN

(


I Question Not Asked


85.2%


86.1%

84.1%

80.4%

E84.4%

75.9%

S84.5%


I I%
20% 40% 60%


80%


100%


Reflects distribution among survey respondents
Sources: 1. Medicaid Managed Care Surveys, FY 2005 and Medicaid Fee-for-Service Surveys, FY2005, Florida Center for Medicaid & the Uninsured.
2. Medicaid HMO Surveys, FY2005, State Center for Health Statistics
65













Respondents who reported having switched PCPs since becoming enrolled in Medicaid were asked
how difficult it was to find a satisfactory PCP in their plan. Overall, nearly three-quarters (73%) of
respondents reported it was "not a problem" to find a provider that they were "happy with." This figure
compares favorably with national CAHPS figures*, in which 67% of adult Medicaid enrollees reported it
was "not a problem" to find a PCP. Twelve percent of Florida Medicaid enrollees surveyed reported
having "a small problem" finding a PCP, and 15% reported it was "a big problem."

The seven plans differed significantly on this measure, with FFS and PSN enrollees reporting most
favorably. Seventy-eight percent of enrollees in each of these plans reported it was "not a problem" to
find a PCP. Among the HMO, MediPass and MPN groups, 64-69% reported it was "not a problem" to
find a satisfactory PCP.

*Source: 2005 CAHPS Health Plan Survey Chartbook, National CAHPS Benchmarking Database


Medicaid Medicaid
Problem Getting Me a Me a Medicaid MediPass MediPass MPN: MPN:
Overall HMO PSN
Satisfactory Doctor or Nurse waited) (weite) FFS Choice No Choice NetPass PhyTrust
(weighted) (weighted)
Big Problem 15.1% 21.6% 11.2% 18.7% 21.8% 18.0% 18.7% 12.5%
Small Problem 12.1% 14.4% 10.8% 13.8% 12.5% 14.9% 12.3% 9.8%
No Problem 72.8% 64.0% 78.0% 67.5% 65.7% 67.1% 69.0% 77.7%

Reflects distribution among survey respondents
Sources: 1. Medicaid Managed Care Surveys, FY 2005 and Medicaid Fee-for-Service Surveys, FY2005, Florida Center for Medicaid & the Uninsured.
2. Medicaid HMO Surveys, FY2005, State Center for Health Statistics









Percent of Respondents Reporting that it was "not a problem" to find a satisfactory
doctor or nurse in Medicaid:


Medicaid Overall

Medicaid HMO

Medicaid FFS

MediPass Choice

MediPass No Choice

MPN: NetPass

MPN: PhyTrust

PSN


0%


20% 40%


60%


E 72.8%
64.0%

- 78.0%

67.5%

65.7%

67.1%

I 69.0%
- 77.7%

80% 100%


Reflects distribution among survey respondents
Sources: 1. Medicaid Managed Care Surveys, FY 2005 and Medicaid Fee-for-Service Surveys, FY2005, Florida Center for Medicaid & the Uninsured.
2. Medicaid HMO Surveys, FY2005, State Center for Health Statistics
67










Specialty Care











Respondents who reported that they had needed to see a specialist physician in the 6 months prior to interview
were asked how difficult it had been to see that specialist. Their responses varied greatly. Overall, more than
two-thirds of respondents (68%) reported it was "not a problem." This is a favorable finding, considering that
the national CAHPS average for Medicaid adults is 64% reporting it was "not a problem" to see a specialist.
However, thirteen percent of Medicaid enrollees reported it was "a small problem" seeing a specialist, and 20%
reported it was "a big problem." Compared with the national CAHPS benchmarks, these figures are less
favorable. Nationally, 18% of Medicaid adults report "a small problem" and 17% report "a big problem" seeing a
specialist. So, while the majority of respondents in Medicaid reported no problems seeing a specialist, a sizable
minority nearly one-third reported having a problem, and almost half of those reported it was "a big problem."
The reports of the six Medicaid plans differed significantly on this measure, with the FFS population reporting
most favorably by far. More than three-quarters of FFS respondents reported it was "not a problem" to see a
specialist in Medicaid. The HMO group appeared to report least favorably on this measure, though a statistical
comparison with the other populations is not possible. Still, more than half (52%) of respondents in the HMO
group reported it was "not a problem" to find a specialist.
*Source: 2005 CAHPS Health Plan Survey Chartbook, National CAHPS Benchmarking Database
Medicaid Medicaid
Difficulty Seeing Overall HMO Medicaid MediPass MediPass MPN: MPN:
a Specialist (weighted) (weighted) FFS Choice No Choice NetPass PhyTrust PSN

Big Problem 19.5% 28.6% 14.3% 25.6% 30.3% 20.8% 19.6% 24.4%
Small Problem 12.5% 19.9% 9.5% 13.5% 12.2% 19.0% 16.3% 11.4%
Not a Problem 68.1% 51.5% 76.2% 61.0% 57.5% 60.2% 64.1% 64.2%
Reflects distribution among survey respondents
Sources: 1. Medicaid Managed Care Surveys, FY 2005 and Medicaid Fee-for-Service Surveys, FY2005, Florida Center for Medicaid & the Uninsured.
2. Medicaid HMO Surveys, FY2005, State Center for Health Statistics







E a s o f S e i g a S pa I


HA Problem U Not a Problem


Medicaid Overall .

Medicaid HMO

Medicaid FFS 23. 76.

MediPass Choice 39.gg 1.

MediPass No Choice

MPN: NetPass 3.:86 0.

MPN: PhyTrust 3 .

PSN 5. 64.


0
0%


20%


40%


60%


80%


100%


Reflects distribution among survey respondents
Sources: 1. Medicaid Managed Care Surveys, FY 2005 and Medicaid Fee-for-Service Surveys, FY2005, Florida Center for Medicaid & the Uninsured.
2. Medicaid HMO Surveys, FY2005, State Center for Health Statistics










Other Types of Care













Respondents were asked if, in the 6 months prior to interview, they had experienced an illness or injury
requiring immediate medical attention. Those who reported affirmatively were asked if they had gotten
that care as soon as they wanted it. Sixty percent of Medicaid enrollees overall reported that they
"always" got the care as soon as they wanted it. This figure compares favorably with national CAHPS
reports, which show 56% of adult Medicaid enrollees reporting that they "always" got such care as soon
as they wanted it. Among survey respondents, 21% reported that they "usually" got care for illnesses
or injuries as soon as desired, and fifteen percent reported that they "sometimes" did. Five percent
reported they "never" got that care as soon as they felt necessary.

The reports of the seven Medicaid plans differed significantly on this measure, with the PSN population
reporting most favorably. Seventy-five percent of PSN enrollees reported that they "always" received
care as soon as they wanted it. The MPN: PhyTrust group reported least favorably with 50% of
respondents reporting that they "always" got urgent care as soon as desired.

*Source: 2005 CAHPS Health Plan Survey Chartbook, National CAHPS Benchmarking Database

Got Immediate Care for Medicaid Medicaid
Illness or Injury as Soon as Overall HMO Medicaid MediPass MediPass MPN: MPN:
Wanted (weighted) (weighted) FFS Choice No Choice NetPass PhyTrust PSN
Never 4.7% 6.1% 4.2% 4.5% 6.6% 2.0% 7.0% 2.2%
Sometimes 14.5% 19.1% 11.4% 19.1% 14.9% 24.8% 26.1% 16.1%
Usually 21.3% 19.2% 23.4% 18.5% 17.3% 16.3% 16.9% 6.6%
Always 59.5% 55.7% 61.1% 58.0% 61.3% 56.9% 50.0% 75.2%

Reflects distribution among survey respondents
Sources: 1. Medicaid Managed Care Surveys, FY 2005 and Medicaid Fee-for-Service Surveys, FY2005, Florida Center for Medicaid & the Uninsured.
2. Medicaid HMO Surveys, FY2005, State Center for Health Statistics









Percent reporting that they "always" got an appointment for urgent care as quickly
as they wanted:


Medicaid Overall

Medicaid FFS

Medicaid FFS

MediPass Choice

MediPass No Choice

MPN: NetPass

MPN: PhyTrust

PSN


59.5%

I 55.7%

61.1%

58.0%

61.3%

I 56.9%

50.0%


I I


0% 20% 40% 60% 80% 100%
Reflects distribution among survey respondents
Sources: 1. Medicaid Managed Care Surveys, FY 2005 and Medicaid Fee-for-Service Surveys, FY2005, Florida Center for Medicaid & the Uninsured.
2. Medicaid HMO Surveys, FY2005, State Center for Health Statistics
73


75.2%


I













Sixty-four percent of Medicaid enrollees reported that, when they needed urgent care for an illness or
injury, they received that care the same day or the next day. Twelve percent reported waiting 2 to 3
days for care, and 24% reported waiting 4 days or longer for urgent care. Responses on this survey
question were cross-referenced with those from the question regarding satisfaction with wait times for
urgent care appointments. Of those who reported waiting 4 days or longer for an appointment, 61%
reported that they "usually" or "always" got appointments as soon as desired. This suggests that those
patients who waited 4 days or longer for an appointment may have intentionally booked these
appointments days in advance, and, thus, were not unsatisfied with their wait times.

The reports of the program components did not vary significantly on this measure. However, the
performance of the PSN group is worthy of mention. This group had the highest percentage (64%) of
respondents reporting that they received urgent care the same day. The next most favorable report
was from the FFS group, at 51%. Seventeen percent of PSN enrollees reported waiting 4 days or
longer for urgent care, compared with the next most favorable report, which was from the MPN:
PhyTrust group, at 23%.

Days Waiting To Get Care Medicaid Medicaid
Medicaid MediPass MediPass MPN: MPN:
for Illness or Injury that Overall HMO M d iPas MediPSN
Required Immediate Care (weighted) FFS choice No Choice NetPass PhyTrust
Required Immediate Care (weighted) (weighted)


Same day 50.5,
1 day 13.69
2 to 3 days 12.1 ,
4 days or longer 23.99


51.2% 49.7% 44.9% 46.5% 45.8% 64.0%
13.6% 11.5% 18.6% 14.2% 12.0% 8.1%
11.7% 12.7% 12.6% 12.3% 19.0% 11.0%
23.5%1 26.1% 24.0% 27.1%1 23.3% 16.9%


HMO Enrollees, who were surveyed separately, were not asked this question Reflects distribution among survey respondents
es: 1. Medicaid Managed Care Surveys, FY 2005 and Medicaid Fee-for-Service Surveys, FY2005, Florida Center for Medicaid & the Uninsured.
2. Medicaid HMO Surveys, FY2005, State Center for Health Statistics


Sourc









Percent reporting that they got an appointment for urgent medical care the same day
or next day:

Medicaid Overall 64.1%

Medicaid HMO Question Not Asked

Medicaid FFS 64.8%

MediPass Choice 61.2%

MediPass No Choice 63.5%

MPN: NetPass
60.7%

MPN: PhyTrust 57.8%

PSN 72.1%

0% 20% 40% 60% 80% 100%

Reflects distribution among survey respondents
Sources: 1. Medicaid Managed Care Surveys, FY2005 and Medicaid Fee-for-Service Surveys, FY2005, Florida Center for Medicaid & the Uninsured.
2. Medicaid HMO Surveys, FY2005, State Center for Health Statistics
75













Respondents were asked if, in the 6 months prior to interview, they had made an appointment for non-
urgent health care. The 60% who reported affirmatively were asked if they had gotten that care as
soon as they wanted it. Sixty percent of Medicaid enrollees overall reported that they "always" got the
care as soon as they wanted it. This figure compares quite favorably with national CAHPS reports,
which show 48% of adult Medicaid enrollees reporting that they "always" got such care as soon as
they wanted it. Among survey respondents, 19% reported that they "usually" got non-urgent care as
soon as desired, and eighteen percent reported that they "sometimes" did. Four percent reported they
"never" got that care as soon as they felt necessary.

The reports of the seven Medicaid plans differed significantly on this measure, with the FFS population
reporting most favorably. Sixty-four percent of FFS enrollees reported that they "always" received care
as soon as they wanted it. The MediPass No Choice group reported least favorably with 46% of
respondents reporting that they "always" got non-urgent care as soon as desired.

*Source: 2005 CAHPS Health Plan Survey Chartbook, National CAHPS Benchmarking Database
Medicaid Medicaid
GotAppointmentforNon-Urgent Overall HMO Medicaid MediPass MediPass MPN: MPN:
Health Care as Soon as Wanted
Health Care as Soon as Wanted (weighted) (weighted) FFS Choice No Choice NetPass PhyTrust PSN
Never 3.5% 5.4% 2.3% 4.7% 5.3% 2.8% 7.9% 7.7%
Sometimes 17.8% 22.2% 15.2% 18.7% 24.2% 18.4% 19.5% 19.8%
Usually 19.2% 20.1% 18.9% 16.6% 24.7% 18.9% 19.5% 15.9%
Always 59.5% 52.4% 63.6% 60.0% 45.8% 59.9% 53.2% 56.6%

Reflects distribution among survey respondents
Sources: 1. Medicaid Managed Care Surveys, FY 2005 and Medicaid Fee-for-Service Surveys, FY2005, Florida Center for Medicaid & the Uninsured.
2. Medicaid HMO Surveys, FY2005, State Center for Health Statistics









Percent reporting that they "always" got an appointment for routine care as quickly
as they wanted:


Medicaid Overall

Medicaid HMO

Medicaid FFS

MediPass Choice

MediPass No Choice


59.5%


52.4%


-I


63.6%

60.0%


-I


45.8%


MPN: NetPass

MPN: PhyT rust

PSN


0%


E 59.9%

53.2%

56.6%


20%


40%


60%


Sources: 1.
2.


Reflects distribution among survey respondents
Medicaid Managed Care Surveys, FY 2005 and Medicaid Fee-for-Service Surveys, FY2005, Florida Center for Medicaid & the Uninsured.
Medicaid HMO Surveys, FY2005, State Center for Health Statistics


80%


100%


I I I













Sixty-nine percent of Medicaid enrollees reported that, when they needed non-urgent care, they received
that care within one week of calling for an appointment. Twelve percent reported waiting between 1 and
2 weeks for the appointment, and 19% reported waiting longer than 2 weeks. Responses on this survey
question were cross-referenced with those from the question regarding satisfaction with wait times for
non-urgent appointments. Of those who reported waiting longer than 2 weeks for an appointment, 64%
reported that they "usually" or "always" got appointments as soon as desired. This suggests that those
patients who waited 2 weeks or longer for an appointment may have intentionally booked these
appointments weeks in advance, and, thus, were not unsatisfied with their wait times.

The reports of the program components varied significantly on this measure. The MPN: PhyTrust group
reported most favorably, with 88% of respondents indicating that they received non-urgent care within two
weeks of calling for an appointment, and only 12% reporting that they waited more than 2 weeks for an
appointment. The PSN group reported least favorably, with 62% reporting that they received an
appointment within two weeks days, and 38% reporting that they waited longer than 2 weeks. Cross-
referencing with prior survey measures, as described above, reveals that 44% of PSN respondents who
waited more than 2 weeks may have intentionally scheduled their appointments far in advance.

Making an Appointment for Medicaid Medicaid
Non-Urgent Care and Seeing Overall HMO Medicaid MediPass MediPass MPN: MPN:
a Provider (weighted) (weighted) FFS Choice No Choice NetPass PhyTrust PSN


Same day 14.50/c
1 to 7 days 54.50
8-14 days 12.40/c
15 days or longer 18.60/c


13.7% 17.0% 17.7% 13.7% 12.8% 16.0%
53.6% 58.3% 56.6% 55.6% 62.0% 35.4%
13.3% 8.5% 10.0% 16.6% 13.4% 10.3%
19.4% 16.1% 15.8% 14.1% 11.8% 38.3%


HMO Enrollees, who were surveyed separately, were not asked this question Reflects distribution among survey respondents
Sources: 1. Medicaid Managed Care Surveys, FY 2005 and Medicaid Fee-for-Service Surveys, FY2005, Florida Center for Medicaid & the Uninsured.
2. Medicaid HMO Surveys, FY2005, State Center for Health Statistics









Percent reporting that they got an appointment for routine care within 2 weeks:


Medicaid Overall

Medicaid HMO

Medicaid FFS

MediPass Choice

MediPass No Choice

MPN: NetPass

MPN: PhyTrust

PSN


Question Not Asked


81.4%



80.6%

83.8%

S84.3%

S85.9%

M 88.2%


61.7%


I I I I I I
0% 20% 40% 60% 80% 100%
Reflects distribution among survey respondents
Sources: 1. Medicaid Managed Care Surveys, FY 2005 and Medicaid Fee-for-Service Surveys, FY2005, Florida Center for Medicaid & the Uninsured.
2. Medicaid HMO Surveys, FY2005, State Center for Health Statistics
79











Respondents were asked if, in the 6 months prior to interview, they had visited an emergency room
(ER) to get treatment for themselves. While most Medicaid respondents (64%) indicated that they had
not, more than one-third (37%) indicated that they had visited an ER, with 17% indicating they had
made 2 or more visits. It is important to note that these figures are based on self-report. It may be
difficult for respondents to recall whether a particular ER visit occurred during the 6 month time frame
referenced in the question, and, thus, the number of visits reported for this time period, could be an
inflated figure.

The number of ER visits did not differ significantly by plan.


Medicaid Medicaid
# of Emergency Room Medcad Medad Medicaid MediPass MediPass MPN: MPN: P
Visits in last 6 months (weighted) ( ) FFS Choice No Choice NetPass PhyTrust
(weighted) (weighted)
None 63.5% 61.2% 64.8% 60.9% 62.4% 64.9% 63.8% 64.1%
1 19.3% 19.3% 19.4% 19.1% 19.6% 18.1% 17.0% 16.7%
2ormore 17.2% 19.5% 15.8% 20.1% 18.0% 17.0% 19.2% 19.2%


Reflects distribution among survey respondents


Sources: 1.
2.


Medicaid Managed Care Surveys, FY 2005 and Medicaid Fee-for-Service Surveys, FY2005, Florida Center for Medicaid & the Uninsured.
Medicaid HMO Surveys, FY2005, State Center for Health Statistics








R Vt i n


SOne visit U Two or more visits

Medicaid Overall 1 .

Medicaid HMO .

Medicaid FFS 14 1 .

MediPass Choice 1 2 .

MediPass No Choice

MPN: NetPass 1

MPN: PhyTrust 7. 1 .

0% 20% 40% 60% 80% 100%
Reflects distribution among survey respondents


Sources: 1. Medicaid Managed Care Surveys, FY2005 and Medicaid Fee-for-Service Surveys, FY2005, Florida Center for Medicaid & the Uninsured.
2. Medicaid HMO Surveys, FY2005, State Center for Health Statistics
81













Respondents who reported needing care, tests, or treatment in the 6 months prior to interview (73%)
were asked how difficult it was to get the needed care. Overall, 70% of respondents reported it was
"not a problem" to get that care in Medicaid, while 17% report a "small problem" and 14% report a "big
problem." While these figures do show that a majority of enrollees had no problems getting care, it
should be noted that the figures are less favorable than the national average for Medicaid-enrolled
adults. Nationally, 75% reported it was "not a problem" getting care, tests, or treatment, while 16%
report a "small problem," and 9% report a "big problem."

The FFS, MediPass, MPN, and PSN groups did not differ significantly on this measure.

*Source: 2005 CAHPS Health Plan Survey Chartbook, National CAHPS Benchmarking Database


Medicaid Medicaid
Measure Overall HMO Medicaid MediPass MediPass MPN: MPN:
(weighted) (weighted) FFS Choice No Choice NetPass PhyTrust PSN
Big Problem 13.6% 17.4% 10.9% 18.6% 16.4% 13.2% 15.3% 18.6%
Small Problem 16.7% 19.8% 15.6% 16.2% 17.8% 20.5% 16.8% 14.9%
Not a Problem 69.6% 62.8% 73.5% 65.2% 65.7% 66.3% 67.9% 66.5%


Reflects distribution among survey respondents


Sources: 1.
2.


Medicaid Managed Care Surveys, FY 2005 and Medicaid Fee-for-Service Surveys, FY2005, Florida Center for Medicaid & the Uninsured.
Medicaid HMO Surveys, FY2005, State Center for Health Statistics










Percent of Respondents reporting that it was "not a problem" to get needed care,
tests, or treatment:

Medicaid Overall 69.6%

Medicaid HMO 62.8%

Medicaid FFS 73.5%

MediPass Choice 65.2%

MediPass No Choice 65.7%

MPN: NetPass 66.3%

MPN: PhyTrust 67.9%

PSN 66.5%

0% 20% 40% 60% 80% 100%
Reflects distribution among survey respondents
Sources: 1. Medicaid Managed Care Surveys, FY2005 and Medicaid Fee-for-Service Surveys, FY2005, Florida Center for Medicaid & the Uninsured.
2. Medicaid HMO Surveys, FY2005, State Center for Health Statistics
83












Most Medicaid enrollees surveyed reported that they did not need approval from their health plan to get
needed care, tests, or treatment. However, more than one-third (36%) reported that they did need to
get approval for this care. Those who did need approval were asked whether they experienced
problems associated with delays in getting health care while awaiting approval from Medicaid. Roughly
half of respondents (52%) reported that delays were "not a problem," while just under one-quarter
(23%) indicated it was "a small problem," and one-quarter (25%) reported that delays were "a big
problem." These figures compare rather unfavorably with national CAHPS figures*, in which 56% of
adult Medicaid respondents indicated that delays while awaiting approval were "not a problem," 26%
reported it was "a small problem," and 17% reported it was "a big problem."

There were no significant differences in the programs on this measure.

*Source: 2005 CAHPS Health Plan Survey Chartbook, National CAHPS Benchmarking Database


Medicaid Medicaid
Medicaid MediPass MediPass MPN: MPN:
Measure Overall HMO PSN
waited) waitedd) FFS Choice No Choice NetPass PhyTrust
(weighted) (weighted)
Approval needed from health plan
for care, tests, or treatments 35.9% 49.4% 29.6% 41.6% 33.5% 37.8% 41.0% 34.5%
Delays While Waiting for Approval
from Program
Big Problem 24.6% 25.3% 25.9% 21.8% 18.1% 16.7% 23.9% 18.2%
Small Problem 23.3% 21.5% 23.5% 25.0% 28.7% 22.9% 22.0% 25.0%
Not a Problem 52.2% 53.2% 50.6% 53.2% 53.2% 60.4% 54.1% 56.8%


Reflects distribution among survey respondents


Sources: 1.
2.


Medicaid Managed Care Surveys, FY 2005 and Medicaid Fee-for-Service Surveys, FY2005, Florida Center for Medicaid & the Uninsured.
Medicaid HMO Surveys, FY2005, State Center for Health Statistics








Dly FinkU Gt Approva fo Care


Medicaid Overall

Medicaid HMO

Medicaid FFS

MediPass Choice

MediPass No Choice

MPN: NetPass

MPN: PhyTrust

PSN


IA Big Problem HA Small Problem

4 .6 2 .3

2 1 .5

25.9% 23.5%

1 .8 25 .0

18.1% 28.7

6.7 S2 .9

3 .9 2 .0

1 5 .0


Not a Problem

52.2%

53.2%

50.6%

53.2%

53.2%

60.4%

54.1%

56.8%


I I I I I I
0% 20% 40% 60% 80% 100%

Reflects distribution among survey respondents
Sources: 1. Medicaid Managed Care Surveys, FY 2005 and Medicaid Fee-for-Service Surveys, FY2005, Florida Center for Medicaid & the Uninsured.
2. Medicaid HMO Surveys, FY2005, State Center for Health Statistics
85














Medicaid enrollees were asked if they got any new prescriptions for medication or needed to refill any
prescriptions in the 6 months prior to interview. Seventy-eight percent of respondents overall responded
affirmatively. There was a statistically significant difference between the Medicaid programs on this
measure, with figures ranging from 80% of respondents from the FFS program reporting that they
needed a prescription, to only 65% among MPN: PhyTrust respondents. This finding is not surprising,
given that the FFS group includes a large portion of enrollees who are elderly, while the MPN: PhyTrust
group includes a large portion of younger enrollees (as reported by survey respondents).

Those who reported that they did get a new prescription or a refill were asked "how much of a problem, if
any" it had been to get this prescription through Medicaid. Most respondents (72%) reported it was "not
a problem," while 16% indicated it was "a small problem," and 12% indicated it was "a big problem" to
get their prescriptions through Medicaid. There was no significant difference between the programs on
this measure.


SMedicaid
HMO Medicaid
weightedd) FFS


Medicaid
Measure Overall
(weighted)

Did Patient Get new prescription or
Refill a Prescription 78.2%
How much of a Problem for Patient to
get Prescription from Medicaid
A big problem 12.0%
A small problem 15.6%
Not a problem 72.3%


HMO Enrollees, who were surveyed separately, were not asked this question


MediPass MediPass
Choice I No Choice


MPN:
NetPass


MPN:
PhyTrust


PSN


79.6% 75.3% 75.9% 69.5% 65.2% 72.7%



12.9% 10.7% 7.7% 5.5% 8.9% 6.6%
16.3% 12.9% 13.7% 16.4% 14.0% 15.6%
70.8% 76.4% 78.6% 78.1% 77.1% 77.8%


Reflects distribution among survey respondents


Medicaid Managed Care Surveys, FY 2005 and Medicaid Fee-for-Service Surveys, FY2005, Florida Center for Medicaid & the Uninsured.
Medicaid HMO Surveys, FY2005, State Center for Health Statistics


Sources: 1.
2.


_









O aini ng I i [ I P r e s c [ilt D r g [1hro u I *1 [6


Percent of respondents reporting that they got a new
prescription or a refill in the 6 months prior to interview


Percent of respondents reporting it was "not a
problem" to get prescriptions through Medicaid


Medicaid Overall


Medicaid Overall


78.2%


Question Not Asked
Medicaid HMO


Medicaid FFS


MediPass Choice

MediPass No
Choice


MPN: NetPass


MPN: PhyTrust


PSN


79.6%


75.3%

75.9%


69.5%


65.2%


Medicaid HMO Question Not Asked


Medicaid FFS


MediPass Choice

MediPass No
Choice

MPN: NetPass


MPN: PhyTrust


72.7%


72.3%





70.8%


I 76.4%


S78.6%


- 78.1%


S77.1%


S77.8%


0% 20% 40% 60% 80% 100%


0% 20% 40% 60%


100%


Reflects distribution among survey respondents
Medicaid Managed Care Surveys, FY 2005 and Medicaid Fee-for-Service Surveys, FY2005, Florida Center for Medicaid & the Uninsured.
Medicaid HMO Surveys, FY2005, State Center for Health Statistics


Sources: 1.
2.















Ten percent of Medicaid enrollees surveyed reported that they had called Medicaid for transportation
assistance some time in the 6 months prior to survey. Slightly less than three-quarters (73%) of
respondents needing transportation assistance indicated that they "usually" or "always" got the
transportation assistance that they needed, and more than three-quarters of respondents (78%)
indicated that the transportation assistance "usually" or "always" met their needs.

It should be noted that these measures included relatively small numbers of patients, and, thus,
inferences about differences between programs cannot reliably be made.


Medicaid
HMO
(weiQhted)


Medicaid
FFS


Medicaid
Measure Overall
(weighted)

Did Patient call Medicaid to get
help with transportation 10.1%
When called, how often did patient
get help with transportation
Never or Sometimes 26.8%
Usually or Always 73.2%
How often did transportation
assistance meet patient needs
Never or Sometimes 22.2%
Usually or Always 77.8%


HMO Enrollees, who were surveyed separately, were not asked this question


Sources: 1.
2.


MediPass MediPass
Choice I No Choice


MPN:
NetPass


MPN:
PhyTrust


PSN


9.4% 13.0% 11.3% 13.5% 8.3% 12.7%



24.2% 37.5% 19.0% 26.1% 40.0% 31.8%
75.8% 62.5% 81.0% 73.9% 60.0% 68.2%



24.1% 22.0% 7.9% 16.3% 13.6% 30.6%
75.9% 78.1% 92.1% 83.7% 86.4% 69.5%


Reflects distribution among survey respondents


Medicaid Managed Care Surveys, FY 2005 and Medicaid Fee-for-Service Surveys, FY2005, Florida Center for Medicaid & the Uninsured.
Medicaid HMO Surveys, FY2005, State Center for Health Statistics








RefleTsrenspondents'n experiences ino6imonths priorato


Reflects respondents' experiences in 6 months prior to
requesting assistance:

Usually or Always


Received
Transportation
Assistance When
Requested




Transportation
Assistance Met
Patient's Needs


0%


20%


40%


interview, among those


* Never or Sometimes


60%


80%


100%


Does not include data from HMO Enrollees. Reflects distribution among survey respondents
Sources: 1. Medicaid Managed Care Surveys, FY 2005 and Medicaid Fee-for-Service Surveys, FY2005, Florida Center for Medicaid & the Uninsured.
2. Medicaid HMO Surveys, FY2005, State Center for Health Statistics


:*. *.
732%268







77.% 2.2













Medicaid covers special health needs, such as medical equipment, physical and occupational therapy,
home health care, and mental health care. Relatively few Medicaid enrollees report needing these
services, yet they are crucial for those who do require them. Medicaid enrollees surveyed were asked
about their need for these services, and those responding affirmatively were asked "how much of a
problem, if any" they had in obtaining these services through Medicaid.

Eighty-two percent of respondents who needed special medical equipment reported it was "not a
problem" to get that equipment through Medicaid. Eighty percent of respondents who needed special
therapy, like speech, occupational, or physical therapy, reported it was "not a problem" to get this
therapy through Medicaid, and 77% of those who needed home health assistance reported it was "not a
problem" getting that assistance. Seventy-four percent of respondents who needed mental health
treatment or counseling reported it was "not a problem" to get this care through Medicaid.

It should be noted that these measures included relatively small numbers of patients, and, thus,
inferences about differences between programs cannot reliably be made.


How much of a problem How much of a problem was it to How much of a problem How much of a problem was
Measure was it to get special get special therapy (e.g., speech, was it to get home it to get needed mental
medical equipment occupational, or physical therapy) health care or assistance health treatment or
through Medicaid through Medicaid through Medicaid counseling through Medicaid
Abig problem 10.0% 13.0% 17.0% 16.5%
A small problem 7.8% 7.7% 6.1% 9.5%
Not a problem 82.2% 79.3% 76.9% 74.0%

Reflects distribution among survey respondents
Sources: 1. Medicaid Managed Care Surveys, FY 2005 and Medicaid Fee-for-Service Surveys, FY2005, Florida Center for Medicaid & the Uninsured.
2. Medicaid HMO Surveys, FY2005, State Center for Health Statistics












Percent reporting it was "not a problem" to obtain needed equipment, services, or
care through Medicaid, among those needing equipment, services, or care:


Medical Equipment


Special Therapy


Home Health


Mental Health
Treatment/Counseling


0%


20%


40%


60%


* 79.3%



176.9%



74.0%


80%


Does not include data from HMO Enrollees.


Sources: 1.
2.


Reflects distribution among survey respondents


Medicaid Managed Care Surveys, FY 2005 and Medicaid Fee-for-Service Surveys, FY2005, Florida Center for Medicaid & the Uninsured.
Medicaid HMO Surveys, FY2005, State Center for Health Statistics


82.2%


100%














Communicating with Providers













Respondents were asked about their experiences with office staff in their Medicaid providers' offices.
Ninety-one percent of respondents overall indicated that office staff were "usually" or "always" courteous
and respectful to them, while 9% indicated they were "never" or "sometimes" respectful. Eighty-four
percent of respondents reported that staff were "usually" or "always" helpful, while 16% indicated they
were "never" or "sometimes" helpful.

Statistically significant differences were found between the programs on these measures, but the
differences were too small to be of practical value. In general, the FFS group reported most positively
on both measures, with 93% reporting that staff were "usually" or "always" respectful, and 88% reporting
that staff were "usually" or "always" helpful. The reports of the MediPass No Choice and MPN: NetPass
groups were very similar to those of FFS.

Medicaid Medicaid
Measure Overall HMO Medicaid MediPass MediPass MPN: MPN:
(weighted) (weighted) FFS Choice No Choice NetPass PhyTrust PSN
Office Staff at Doctor's Office
Were Courteous and Respectful
Never or Sometimes 8.8% 12.7% 6.8% 11.9% 7.0% 6.9% 12.0% 15.1%
Usually or Always 91.2% 87.3% 93.2% 88.1% 93.0% 93.1% 88.0% 84.9%
Office Staff at Doctor's Office
Were Helpful
Never or Sometimes 15.8% 22.7% 12.3% 20.7% 15.4% 14.2% 19.5% 18.4%
Usually or Always 84.2% 77.3% 87.7% 79.3% 84.6% 85.8% 80.5% 81.6%
Reflects distribution among survey respondents


Sources: 1.
2.


Medicaid Managed Care Surveys, FY 2005 and Medicaid Fee-for-Service Surveys, FY2005, Florida Center for Medicaid & the Uninsured.
Medicaid HMO Surveys, FY2005, State Center for Health Statistics










Percent reporting that office staff at Medicaid providers' offices were "usually" or
"always" courteous and respectful, and "usually" or "always" helpful:


* Staff Usually or Always Helpful

Medicaid Overall

Medicaid HMO

Medicaid FFS

MediPass Choice

MediPass No Choice

MPN: NetPass

MPN: PhyTrust

PSN


* Staff Usually or Always Courteous and Respectful


.2%
87.%


.88.


88.




84.90%
85.8%


1.2%

3%

93.2%

1%

93.0%

93.1%

0%


II I I I
0% 20% 40% 60% 80% 100%
Reflects distribution among survey respondents
Sources: 1. Medicaid Managed Care Surveys, FY 2005 and Medicaid Fee-for-Service Surveys, FY2005, Florida Center for Medicaid & the Uninsured.
2. Medicaid HMO Surveys, FY2005, State Center for Health Statistics













Respondents were asked a series of questions about whether their Medicaid providers communicated
well with them. The vast majority of respondents indicated that their providers did communicate well.
Eighty-seven percent indicated that their provider "usually" or "always" listened carefully, 85% said their
provider "usually" or "always" explained things so that they could understand, and 89% reported that
their provider "usually" or "always" showed respect for what they (the patient) said. Responses to these
three questions were cross-referenced to show that 76% of Medicaid respondents overall indicated that
their provider "usually" or "always" performed all three of these tasks.

The Medicaid programs differed significantly on these measures, but the differences were small enough
to be of little practical value. The FFS group reported most positively on all three of these measures,
with 88% reporting that their provider "usually" or "always" listened carefully, 88% reporting that their
provider "usually" or "always" explained things so that they could understand, and 92% reporting that
their provider "usually" or "always" showed respect for what they said.

Medicaid Medicaid
Medcai Medai Medicaid MediPass MediPass MPN: MPN:
Measure Overall HMO PSN
waited) waitedd FFS Choice No Choice NetPass PhyTrust
(weighted) (weighted)
Doctor or Other Provider "Usually" or
"Always" Listened Carefully 86.6% 83.5% 88.4% 85.8% 82.8% 86.1% 79.6% 86.7%
Doctor "Usually" or "Always" Explained
Things So That Patient Could Understand 85.1% 80.8% 87.9% 80.7% 82.0% 85.2% 79.9% 86.0%
Doctor "Usually" or "Always" Showed
Respect for What Patient Said 89.0% 84.9% 92.2% 83.5% 83.7% 88.0% 85.2% 88.6%

Reflects distribution among survey respondents
Sources: 1. Medicaid Managed Care Surveys, FY 2005 and Medicaid Fee-for-Service Surveys, FY2005, Florida Center for Medicaid & the Uninsured.
2. Medicaid HMO Surveys, FY2005, State Center for Health Statistics










Combines responses from three questions. Percent of Respondents Reporting That Providers "Usually" or "Always"
Performed the Following Functions:
*"Listened Carefully,"
*"Explained Things So That They (as a patient) Could Understand," and
*"Showed Respect for What They Said"


Medicaid Overall

Medicaid HMO

Medicaid FFS


MediPass Choice

MediPass No Choice

MPN: NetPass

MPN: PhyTrust

PSN

0%


76.1%

71.1%

1 79.1%


71.2%

71.6%

73.1%

68.4%

I 77.3%
I


20% 40% 60%


80%


100%


Reflects distribution among survey respondents


Sources: 1.
2.


Medicaid Managed Care Surveys, FY 2005 and Medicaid Fee-for-Service Surveys, FY2005, Florida Center for Medicaid & the Uninsured.
Medicaid HMO Surveys, FY2005, State Center for Health Statistics












Respondents were asked how often they had difficulty communicating with their Medicaid providers due
to language barriers. Overall, 8% reported that they "always" had difficulty, while 2% "usually" had
difficulty, 15% "sometimes" had difficulty, and 75% "never" had difficulty. In order to gauge the extent of
this difficulty, responses to this question were cross-referenced with data showing the language that the
respondents used to complete this telephone survey. Overall, of those who reported that they "always"
had difficulty, 65% completed the survey in English, which suggests that they may understand English
well enough to hold basic conversations, but not well enough to comprehend the precise and technical
instructions given by their health provider.

There were significant differences in the programs on this measure, with the MediPass Choice, both
MPN groups, and the PSN reporting the most problems, and the FFS group and the MediPass No
Choice group reporting the fewest problems. The HMO group also reported few problems, though a
comparison with the other plans is not possible due to methodological constraints (see methods section
for more information). Not surprisingly, the MediPass Choice, MPN, and PSN groups had the lowest
percentages of respondents reporting that they primarily speak English in the home, while the FFS,
MediPass No Choice and HMO groups were the three groups with the highest percentage of
respondents who primarily speak English in the home.
Medicaid Medicaid
Difficulty Communicating With era HMO Medicaid MediPass MediPass MPN: MPN: P
Doctor Due to Language Barriers waitedd) (weite FFS Choice No Choice NetPass PhyTrust
(weighted) (weighted)
Never 75.4% 74.8% 77.9% 66.8% 73.2% 68.6% 69.0% 68.4%
Sometimes 14.5% 13.4% 14.3% 16.9% 16.4% 16.6% 12.6% 15.1%
Usually 2.2% 2.9% 1.7% 2.6% 2.4% 3.3% 4.8% 2.2%
Always 7.9% 8.9% 6.1% 13.7% 8.1% 11.4% 13.7% 14.4%
Reflects distribution among survey respondents
Sources: 1. Medicaid Managed Care Surveys, FY 2005 and Medicaid Fee-for-Service Surveys, FY2005, Florida Center for Medicaid & the Uninsured.
2. Medicaid HMO Surveys, FY2005, State Center for Health Statistics










In the last 6 months, how often did you have a hard time speaking with or understanding a
doctor or other health providers because you spoke different languages?


* Never


* Sometimes or Usually


Medicaid Overall

Medicaid HMO

Medicaid FFS

MediPass Choice

MediPass No Choice


MPN: NetPass

MPN: PhyTrust


Always


77.9% 6.0%


6.. 9. .6


732 18.8%


7.9%

8.9%

6.1%


13.7%

8.1%


11.4%

13.7%

14.4%


PSN


0%


20%


40%


60%


80%


100%


Reflects distribution among survey respondents


6.6% 19.9%..
69.0% 17.4%

684 17 3 %Y460ll


Sources: 1.
2.


Medicaid Managed Care Surveys, FY 2005 and Medicaid Fee-for-Service Surveys, FY2005, Florida Center for Medicaid & the Uninsured.
Medicaid HMO Surveys, FY2005, State Center for Health Statistics





1


75.4% 116.70%/
Ir~ rw0














Providing interpreter services is problematic for some providers due to the cost and availability of
staff members or services to provide translation. To assess the need for this service, Medicaid
enrollees were asked about whether, in the 6 months prior to the interview, they had needed an
interpreter to help them speak with their health providers. Overall, 8% of enrollees reported that
they had needed an interpreter, while 92% indicated that they had not needed this service. This
figure varied significantly among program components, however. Responses ranged from a high of
22% of PSN enrollees reporting that they needed an interpreter, to a low of 7% among MediPass
No Choice enrollees. This is not a surprising finding, given the geographic distribution of the
programs and the concentration of Hispanic enrollees in areas served by programs like the PSN.


Medicaid Medicaid
Measure Overall HMO Medicaid MediPass MediPass MPN: MPN:
(weighted) (weighted) FFS Choice No Choice NetPass PhyTrust PSN
Needed an Interpreter to Speak with Doctor
or Other Health Provider 8.1% 8.0% 7.5% 10.5% 6.8% 11.5% 10.8% 22.3%
Reflects distribution among survey respondents


Sources: 1.
2.


Medicaid Managed Care Surveys, FY 2005 and Medicaid Fee-for-Service Surveys, FY2005, Florida Center for Medicaid & the Uninsured.
Medicaid HMO Surveys, FY2005, State Center for Health Statistics