• TABLE OF CONTENTS
HIDE
 Front Cover
 About this chartbook
 Table of Contents
 Summary of major findings
 Introduction
 Methods
 Describing the populations
 Experiences with care and...
 The provider-patient relationship...
 Glossary
 Acknowledgement














Title: Florida Medicaid adult enrollee satisfaction : a chartbook comparing managed care arrangements and fee for service
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 Material Information
Title: Florida Medicaid adult enrollee satisfaction : a chartbook comparing managed care arrangements and fee for service
Series 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.
Publication Date: 2006
 Record Information
Bibliographic ID: UF00091284
Volume ID: VID00002
Source Institution: University of Florida
Holding Location: University of Florida
Rights Management: All rights reserved by the source institution and holding location.

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Table of Contents
    Front Cover
        Front Cover
    About this chartbook
        Page 1
        Page 2
    Table of Contents
        Page 3
        Page 4
    Summary of major findings
        Page 5
        Page 6
        Page 7
        Page 8
        Page 9
        Page 10
    Introduction
        Page 11
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        Page 24
    Methods
        Page 25
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        Page 28
        Page 29
        Page 30
    Describing the populations
        Page 31
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        Page 33
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        Page 58
        Page 59
        Page 60
    Experiences with care and satisfaction
        Page 61
        Page 62
        Page 63
        Page 64
        Page 65
        Page 66
        Page 67
        Page 68
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    The provider-patient relationship and cultural competency
        Page 121
        Page 122
        Page 123
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    Glossary
        Page 133
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        Page 136
    Acknowledgement
        Page 137
        Page 138
        Page 139
Full Text
































Com n 6e Ce A
ad Fefr.evc


Florida Center for Medicaid and te Uninsured
SIhp ng. I lh cr Plc


Prepared by
Florida Center for Medicaid and the Uninsured
The University of Florida
Funded by
Florida Medicaid









Abou Thi geetoo


This chartbook presents an analysis of adult enrollee satisfaction with the Florida Medicaid
program during the State Fiscal Year 2006. 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.








































































2












Section 1: Summary of Major Findings............ ................................... 5
Section 2: Introduction ............ .... ........................ ................ .11
Section 3: Methods ............................................................. 25
Section 4: Describing the Populations ............................................ 31
A. Demographics ................................................ 33
B. Health Status .................................................... 51
Section 5: Experiences with Care and Satisfaction ............... ................ 61
A. Primary Care ..................... ............................. 63
B. Specialty Care................................................... 71
C. Other Types of Care .......... ...... ............... .... ........ 75
D. Communicating with Providers.......................................... 95
E. Plan Administration................................................. 113
Section 6: The Provider-Patient Relationship and Cultural Competency. ................ 121
Glossary .................................................................. 133
Acknowledgements............................................................ 137








































































4








Summary of Major Findings








































































6








SUMAR OF MAO F IiIL]2~V IND ~INGS ~I r


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 MPN: NetPass enrollees reported particularly positively.

Enrollees were also overwhelmingly positive about the timeliness of acquiring both non-urgent
and urgent care. Sixty-one 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% among Medicaid adults and 45% among adults with commercial
insurance. The FFS and MPN: NetPass groups reported most positively on this measure.

Sixty-three 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.










Other positive findings from the chartbook include:
*Eighty percent of enrollees reported having a usual source of care.
*Eighty-two percent of enrollees reported their providers "usually" or "always" spent "enough"
time with them.
.The vast majority (84%) reported that they were "usually" or "always" involved in their health
care decision making, and 78% 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. The majority (71%) of respondents indicated it was "not a problem" to see a specialist in
Medicaid.

This figure compares favorably to the national average of 64% among Medicaid adults. However, a
significant portion of enrollees, 29%, report having a problem. More than half of these, or 16% overall,
reported it was "a big problem." 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 79% reported it was "not a problem" to see a specialist, and
9% reported it was "a big problem." The least favorable ratings appeared to come from the HMO
group, though a statistical comparison with the other program components is outside the scope of this
report, due to the fact that the data were gathered differently. Fifty-six percent of the HMO enrollees
reported it was "not a problem" to see a specialist, while 17% reported having "a small problem," and
27% reported having "a big problem."











Most enrollees in Medicaid (71%) reported it was "not a problem" to get needed care, tests, or
treatment through Medicaid. However, nearly 30% reported having a problem, and half of these, or
15% overall, indicated it was "a big problem." Program components did not vary significantly on this
measure. National benchmarks show 75% of adult Medicaid 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 (61%) of
enrollees surveyed reported having problems getting this assistance, with more than half of these, or
33% overall, reporting a "big problem" and 28% overall reporting "a small problem." Only 39% 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, making it impossible to pinpoint the source of the reported problems.

Among the most striking findings presented in this chartbook is the overwhelming portion fifty-nine
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. The Medicaid HMO group 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 (46%) consider themselves to
be in "fair" or "poor" mental health, and 41% of those surveyed scored within the "moderate" to
"severe" depression range on a depression screener. Among the program components, the PSN
group 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.

An important component of health care quality is in the provision of preventive care and lifestyle
advice for health plan enrollees. A large percentage (28%) of Medicaid enrollees report that they
are active tobacco smokers, and some Medicaid plans have a larger portion of smokers than
others. However, Medicaid providers appear to be doing a good job of advising their patients to
stop smoking. Sixty-five percent of respondents who smoke indicated that their Medicaid
providers had advised them to stop smoking in the last 6 months. A majority of respondents (61%)
indicated that their Medicaid providers had talked with them about a healthy diet and healthy
eating habits in the last 6 months, and 65% of respondents said that their providers had advised
them about exercise and physical activity.









Introduction





































































12












Most Medicaid recipients are required to obtain services through managed care. Exceptions to this
rule include those who are dual-enrolled in Medicare or who have other third party coverage, those
who reside in a nursing facility, those who are enrolled in hospice, or those who are enrolled in
Medicaid with limited benefits. These groups 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 structures differ. 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 9 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 due to the lack of providers and the
distance to facilities and providers. The table that follows identifies 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.


Large portions of this section of the chartbook are taken directly from the Florida Medicaid Summary of Services, FY 2005-2006.















PSN


FFS
60%


MPN: PhyTrust
2%

MPN: NetPass
2%

MediPass No
Choice
5%
MediPass
Choice
13%


Medcai Adul E
Program m /Pa a/o Apri 200


FFS


564,799


HMOs 162,715
MediPass Choice 117,984
MediPass No Choice 42,533
MPN/NetPass 15,848
MPN/PhyTrust 17,242
PSN 6,430


Medicaid HMO
17%


Source: Medicaid Administrative Data for April 2006


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 provide all of the covered services required by
each member during the month.


As of April, 2006, there were 12 Medicaid HMOs1
operating in the state, with a total adult (age 21+ years
old) enrollment of more than 162,000 "long-term"2
beneficiaries. Medicaid HMOs are available in 33 of the
67 Florida counties. As a general rule, HMOs are
offered in more urban counties, and, in many densely-
populated counties, five 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. Table 1 (right) gives the total adult
enrollment, as of April, 2006, for each HMO. It is worthy
of note that 4 plans, Amerigroup, Healthease, Staywell,
and United make up 80% of adult Medicaid HMO
enrollment.


AMEI(IGjUUP 29,241 16.Uo
BUENAVISTA 6,299 3.9%
CITRUS HEALTH CARE 3,189 2.0%
HEALTHEASE 47,685 29.3%
HEALTHY PALM BEACHES 466 0.3%
HUMANA FAMILY 11,395 7.0%
JMH HEALTH PLAN 3,511 2.2%
PREFERRED MEDICAL PLAN 4,130 2.5%
STAYWELL 34,837 21.4%
UNITED ELDERCARE 193 0.1%
UNITED HEALTHCARE PLAN 19,080 11.7%
VISTA SOUTH FLORIDA 2,689 1.7%
TOTAL 162,715 100.0%


Source: Medicaid Administrative Data for April 2006


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

I Note that two other HMOs, Total Health Choice and Universal, had not been operating for long enough to be included in these figures.
2 "Long-term" beneficiaries are defined as those who had been continuously enrolled in their plan for 6 months or longer

Large portions of this section of the chartbook are taken directly from the Florida Medicaid Summary of Services, FY 2005-2006.
















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


Source: AHCA Managed Health Care Website, April 2006


rA


Number of Medicaid HMOs Operating in Each Florida County






Number of Adult* Medci [MO E rt : nrolee by Co .1unty**


-K


*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 April 2006


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


7V


rA











MediPass

The Medicaid Provider Access System, or 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
fee-for-service reimbursement for services that are rendered.
Adult enrollment in MediPass exceeds 160,000 adult beneficiaries statewide. Of this
160,000, roughly 118,000 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 42,000 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 2005-2006.











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. MPNs focus on
increasing access to care and managing utilization of a historically underserved minority population.
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.
MPNs support the primary care providers by providing administrative and utilization management
services as a means of containing cost and enhancing the quality of care. PCPs are paid a $3.00 per
member per month case management fee and fee-for-service reimbursement for medical services.
Since its inception, the MPN pilot project has grown from its roots in Broward, Miami-Dade, and Palm
Beach counties. The program is now authorized to operate in 7 Medicaid service areas (Areas 4, 5,
6, 7, 9, 10, and 11) which comprise 26 counties, as shown in the map on the following page.










Large portions of this section of the chartbook are taken directly from the Florida Medicaid Summary of Services, FY 2005-2006. Information
on MPN authorized service areas from Medicaid Health Systems Development.








Avalblt of Miort Phsca Newok by Count


Source: Florida Medicaid Summary of Services, FY 2005-2006


MPNs not available

One or more MPNs available










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 6,000 adults.
Enrollees receive the majority of their health care services 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.
Claims for non-PSN managed services may be submitted directly to the Medicaid fiscal agent for
processing.

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

Low Income Families and Children (TANF)
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

The PSN is paid a monthly administrative allocation payment for the management of its enrollees. PSN
primary care providers are paid a monthly case management fee of $3 per member. Providers rendering
services to PSN enrollees are reimbursed on a fee-for-service basis.

Large portions of this section of the chartbook are taken directly from the Florida Medicaid Summary of Services, FY 2005-2006.










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,
*TANF or 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 45% 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 17%
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.









STANF


Medicaid Overall

Medicaid HMO

Medicaid FFS

MediPass Choice

MediPass No Choice

MPN: NetPass

MPN: PhyTrust

PSN


*g *. egg





S S



*0e


S '. .*
~g e AgS


I
0%
Source: Medicaid administrative data for April 2006


ESSI


Other


38.7%

18.0%

52.8%

14.4%

16.1%

17.1%

17.4%

17.6%


20%


40%


60%


80%


100%


Adult Medicaid Enrollment by Eligibility Category, 2006 1





































































24









Methods





































































26











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, 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 three Medicaid HMOs, Healthy Palm Beaches, Total
Health Choice, and Universal were not surveyed because they enroll relatively few Medicaid
beneficiaries. Together, they represent less than 1% of the total (adult and child) HMO enrollment in
Medicaid. Also, note that United Healthcare Plan and United Eldercare are treated as a single entity for
these purposes.









Most data for this chartbook were collected by means of a telephone survey of 2,190 enrollees, conducted
in the Spring and Summer of 2006. For all but the HMO surveys, which were administered by AHCA
separately (an additional 3,677 surveys), 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-2. These standardized instruments were supplemented with questions about
racial and ethnic disparities and cultural competency, and about provider advice to patients about lifestyle
choices such as smoking and eating habits. 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 enrollees' satisfaction and experience 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 some supplemental questions related to chronic conditions, dental care, and prescription
medicines.
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 U.S. 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 status.

The PHQ-2 is a 2-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 April, 2006. 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 April,
2006 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 60% 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 all survey results given here will
fall within a range of, at most, plus or minus 5% of the given value. The range for some items may be
considerably smaller than 5%.









Describing the Populations





































































32











Demographics













Over 73% of enrollees surveyed were female, while 27% 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 qualifying and
eligibility criteria. Additionally, special coverage is provided for low-income women who are pregnant,
and uninsured women who have been diagnosed with breast or cervical cancer.


*Source: Agency for Health Care Administration, Frequency based on April 2006 data


Reflects distribution among survey respondents


Sources: 1.
2.


Medicaid Managed Care Surveys, FY2006 and Medicaid Fee-for-Service Surveys, FY2006, Florida Center for Medicaid & the Uninsured.
Medicaid HMO Surveys, FY2006, State Center for Health Statistics


Medicaid f Medicaid
Gen der Overall HMO Medicaid MediPass MediPass MPN: MPN: P
Gender Overall HMO PSN
(weighted) (weighted) FFS Choice No Choice NetPass PhyTrust
(weighted) (weighted)
Male 26.6% 22.1% 27.2%1 29.1% 25.3% 29.9% 33.2% 33.7%
Female 73.4% 77.9% 72.8% 70.9% 74.7% 70.1% 66.9% 66.3%







Gede of Enole Surveyed--I


* Females


* Males


Medicaid Overall *.

Medicaid HMO .

Medicaid FFS 7. .

MediPass Choice 7i.9 2.

MediPass No Choice 7.

MPN: NetPass 7 29.9

MPN: PhyTrust ** .

PSN **. .


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

Reflects distribution among survey respondents
Medicaid Managed Care Surveys, FY2006 and Medicaid Fee-for-Service Surveys, FY2006, Florida Center for Medicaid & the Uninsured.
Medicaid HMO Surveys, FY2006, State Center for Health Statistics


Sources: 1.
2.












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, 43% 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 apart, with the program's enrollment being skewed significantly toward the older
groups. Nearly sixty percent of FFS enrollees were aged 65 or older, while 31% were aged 35-64, and
only 9% 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.


Medicaid Medicaid
Age Group Overall Medicaid MediPass MediPassNo MPN: MPN:
Age Group Overall HMO PSN
FFS Choice Choice NetPass PhyTrust
(weighted) (weighted) hoce h
21 34 years old 17.7% 37.4%. 24.5% 30.9% 24.8% 35.9% 15.7%
35- 64 years old 42.6% 52.2% 31.4% 69.0% 65.7% 60.5% 54.9% 72.3%
65 years old or older 39.8% 10.4% 59.7% 6.6% 3.4% 14.7% 9.2% 12.0%


Reflects distribution among survey respondents


Sources: 1.
2.


Medicaid Managed Care Surveys, FY2006 and Medicaid Fee-for-Service Surveys, FY2006, Florida Center for Medicaid & the Uninsured.
Medicaid HMO Surveys, FY2006, State Center for Health Statistics







A g e of E n ol ee S u ve e I


U 21-34 years old


Medicaid Overall

Medicaid HMO

Medicaid FFS

MediPass Choice

MediPass No Choice


* 35-64 years old


65 years or


-*-

-7.- 42


older

39.8%

10.4%

59.7%


24. *% 6 6.

3 0.9% 6 .7


6%

3.4%


PN: NetPass *2 ,' 14.7%

'N: PhyTrust 35. % 549 9.2%

PSN C1 7-. 12.0%
I I I I I
0% 20% 40% 60% 80% 100%
Reflects distribution among survey respondents
Medicaid Managed Care Surveys, FY2006 and Medicaid Fee-for-Service Surveys, FY2006, Florida Center for Medicaid & the Uninsured.
Medicaid HMO Surveys, FY2006, State Center for Health Statistics

37


M

MF


Sources: 1.
2.












The educational attainment of Medicaid enrollees surveyed fell well-short of the state average.
Among Medicaid enrollees surveyed, just over one-quarter (26%) had attained a level of education
beyond high school, while 35% had graduated high school or obtained a GED as their highest level
of educational attainment. Approximately 39% 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 60% 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
Highest Educational Overall M Medicaid MediPass MediPass MPN: MPN: P
Overall HMO PSN
Attainment (wei ) (w FFS Choice No Choice NetPass PhyTrust
(weighted) (weighted)
Did not graduate high school 39.1% 36.0% 40.3% 35.9% 43.2% 36.0% 39.9% 43.4%
High school graduate or GED 35.2% 36.4% 33.9% 38.6% 37.3% 39.7% 33.6% 33.8%
Beyond high school 25.8%W 27.5% 25.8% 25.5% 19.6% 24.3% 26.5% 22.7%


Reflects distribution among survey respondents


Medicaid Managed Care Surveys, FY2006 and Medicaid Fee-for-Service Surveys, FY2006, Florida Center for Medicaid & the Uninsured.
Medicaid HMO Surveys, FY2006, State Center for Health Statistics


Sources: 1.
2.







Educaio[na[l Atta1V~1inm*I~ Uent of Enrolees Suvee [I~ ~I


Percent Who Have Graduated High School or Obtained a GED:


Medicaid Overall 60.9%

Medicaid HMO 64.0%

Medicaid FFS 59.7%

MediPass Choice 64.1%

MediPass No Choice 56.8%

MPN: NetPass 64.0%

MPN: PhyTrust 60.1%

PSN 56.6%

0% 20% 40% 60% 80% 100%
Reflects distribution among survey respondents
Sources: 1. Medicaid Managed Care Surveys, FY2006 and Medicaid Fee-for-Service Surveys, FY2006, Florida Center for Medicaid & the Uninsured.
2. Medicaid HMO Surveys, FY2006, State Center for Health Statistics












Survey data suggest that the Medicaid program is made up of a larger percentage of Hispanics than the
Florida population as a whole. Twenty-eight percent of Medicaid enrollees surveyed reported being of
Hispanic ethnicity, while 19% 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 and PSN groups had the highest portion of Hispanics, at 55% and 41% respectively,
while MediPass No Choice had the lowest portion, at 10%.

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


Reflects
distribution
among
survey


Medicaid Medicaid
Hispanic or Latino Meiaid Meiai Medicaid MediPass MediPass MPN: MPN:
Overall HMO PSN
Origin or Descent waited) waitedd) FFS Choice No Choice NetPass PhyTrust
(weighted) (weighted)
Yes 27.6% 1 24.9% 26.7% 36.0% 10.4% 54.5% 36.4% 40.9%


INo 1 72.4% 0 75.1% i 73.3%1 64.0%1 89.7%1 45.5%1 63.6%1 59.1%1 respondents
Sources: 1. Medicaid Managed Care Surveys, FY2006 and Medicaid Fee-for-Service Surveys, FY2006, Florida Center for Medicaid & the Uninsured.
2. Medicaid HMO Surveys, FY2006, State Center for Health Statistics








Racial1 E~e Copoiio..I1n[] L1Il]I.I Amn Enrolee]sIS[rveyed: Hispanics e1m *


Percent reporting Hispanic or Latino Origin or Descent:


Medicaid Overall 27.6%

Medicaid HMO 24.9%

Medicaid FFS 26.7%

MediPass Choice 36.0%

MediPass No Choice 10.4%

MPN: NetPass

MPN: PhyTrust 36.4%

PSN 40.9%


54.5%


I I I I I
0% 20% 40% 60% 80% 100%
Reflects distribution among survey respondents
Medicaid Managed Care Surveys, FY2006 and Medicaid Fee-for-Service Surveys, FY2006, Florida Center for Medicaid & the Uninsured.
Medicaid HMO Surveys, FY2006, State Center for Health Statistics


Sources: 1.
2.














Three-quarters of the Medicaid population surveyed indicated that the primary language spoken in
their homes was English, while 22% indicated it was Spanish, and 3% identified some other
language. This finding is consistent with the US Census Bureau's report that 23% 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 48% in the MPN: NetPass group to a low of 8% in the MediPass No Choice group.

1Source: US Census Bureau (2000), http://quickfacts.census.gov


Medicaid Medicaid
Primary Language Medicaid Medicaid Medicaid MediPass MediPassNo MPN: MPN:
OverallI HMO PSN
Spoken at Home (weigh) ( ) FFS Choice Choice NetPass PhyTrust
(weighted) (weighted)
English 75.0% 81.1% 74.0% 69.9% 92.4% 51.6% 68.0% 62.2%
Spanish 21.9% 16.4% 22.8% 26.9% 5.3% 44.5% 28.2% 31.5%
Other 3.1% 2.5% 3.2% 3.2% 2.4% 3.8% 3.8% 6.3%


Reflects distribution among survey respondents


Medicaid Managed Care Surveys, FY2006 and Medicaid Fee-for-Service Surveys, FY2006, Florida Center for Medicaid & the Uninsured.
Medicaid HMO Surveys, FY2006, State Center for Health Statistics


Sources: 1.
2.









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

Medicaid Overall 21.9%

Medicaid HMO 16.4%

Medicaid FFS 22.8%

MediPass Choice 26.9%

MediPass No Choice 5.3%

MPN: NetPass 44.5%

MPN: PhyTrust 28.2%

PSN 31.5%

0% 20% 40% 60% 80% 100%
Reflects distribution among survey respondents
Sources: 1. Medicaid Managed Care Surveys, FY2006 and Medicaid Fee-for-Service Surveys, FY2006, Florida Center for Medicaid & the Uninsured.
2. Medicaid HMO Surveys, FY2006, State Center for Health Statistics













Survey data suggest that the Medicaid program is made up of a smaller percentage of Whites than
the Florida population as a whole. Sixty-four percent of Medicaid enrollees surveyed reported being
White (and not multiracial), compared with 81% in the Florida population as a whole.1 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 were put into a distinct race/ethnicity category, roughly 47% of survey
respondents reported being White and non-Hispanic, compared with 63% in Florida as a whole. This
figure is comparable to that found in Medicaid administrative data, in which 42% of Medicaid-enrolled
adults were White.

Significant differences were found between the programs in terms of the portion of White, non-
Hispanics enrolled. The MediPass No Choice group was composed of the largest percentage of
Whites, at 62%, while the PSN was composed of the smallest percentage of Whites, at 11 %.
1Source: US Census Bureau, http://quickfacts.census.gov

Medicaid Medicaid
IMedicaid Medicaid Medicaid MediPass MediPass MPN: MPN:
Race/Ethnicity Categories Overall HMO M M a M Pass M PSN
(weighted) (weighted) FFS Choice No Choice NetPass PhyTrust
(weighted) (weighted)
Hispanic 26.0% 30.4% 25.1% 34.8% 10.0% 53.0% 35.1% 38.9%
White, non-Hispanic 46.6% 27.9% 51.2% 39.3% 62.0% 23.9% 35.1% 11.4%
Black, non-Hispanic 21.1% 35.4% 17.0% 21.2% 23.7% 20.1% 23.4% 46.6%
Other race, non-Hispanic 5.2% 4.6% 5.7% 3.7% 2.9% 1.6% 4.6% 1.7%
Multiracial, non-Hispanic 1.3% 1.7% 1.0% 1.0% 1.3% 1.4% 1.9% 1.4%
Reflects distribution among survey respondents
Sources: 1. Medicaid Managed Care Surveys, FY2006 and Medicaid Fee-for-Service Surveys, FY2006, Florida Center for Medicaid & the Uninsured.
2. Medicaid HMO Surveys, FY2006, 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


46.6%


-I


27.9%


51.2%


-I


62.0%


23.9%


35.1%


11.4%


I I I I I I
0% 20% 40% 60% 80% 100%
Reflects distribution among survey respondents
Medicaid Managed Care Surveys, FY2006 and Medicaid Fee-for-Service Surveys, FY2006, Florida Center for Medicaid & the Uninsured.
Medicaid HMO Surveys, FY2006, State Center for Health Statistics

45


Sources: 1.
2.


39.3%













Survey data suggest that the Medicaid program is made up of a larger percentage of Blacks than the
Florida population as a whole. Twenty-two percent of Medicaid enrollees surveyed reported being Black
(and not multiracial), compared with 16% 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 were put into a distinct race/ethnicity category, roughly 21% of survey respondents reported
being Black and non-Hispanic. This figure is comparable to that found in Medicaid administrative data, in
which 25% 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 47%, while the FFS group was composed of
the smallest percentage of Blacks, at 17%.

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


Medicaid Medicaid
Medihat C e H Medicaid MediPass MediPass MPN: MPN:
Race/Ethnicity Categories Overall HMO PSN
FFS Choice No Choice NetPass PhyTrust
(weighted) (weighted)
Hispanic 26.0% 30.4% 25.1% 34.8% 10.0% 53.0% 35.1% 38.9%
White, non-Hispanic 46.6% 27.9% 51.2% 39.3% 62.0% 23.9% 35.1% 11.4%
Black, non-Hispanic 21.1% 35.4% 17.0% 21.2% 23.7% 20.1% 23.4% 46.6%
Other race, non-Hispanic 5.2% 4.6% 5.7% 3.7% 2.9% 1.6% 4.6% 1.7%
Multiracial, non-Hispanic 1.3% 1.7% 1.0% 1.0% 1.3% 1.4% 1.9% 1.4%
Reflects distribution among survey respondents
Sources: 1. Medicaid Managed Care Surveys, FY2006 and Medicaid Fee-for-Service Surveys, FY2006, Florida Center for Medicaid & the Uninsured.
2. Medicaid HMO Surveys, FY2006, State Center for Health Statistics











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


Medicaid Overall

Medicaid HMO

Medicaid FFS

MediPass Choice

MediPass No Choice

MPN: NetPass

MPN: PhyTrust

PSN


21.1%


35.4%


17.0%

21.2%

I 23.7%

20.1%

E 23.4%


46.6%


0% 20% 40% 60% 80% 100%
Reflects distribution among survey respondents
Medicaid Managed Care Surveys, FY2006 and Medicaid Fee-for-Service Surveys, FY2006, Florida Center for Medicaid & the Uninsured.
Medicaid HMO Surveys, FY2006, State Center for Health Statistics

47


Sources: 1.
2.













Survey respondents were asked how long they had been continuously enrolled in Medicaid. Overall,
roughly 52% reported having been enrolled for 5 or more years, 28% reported being enrolled between 2
and 5 years, 12% reported 1 to 2 years, and 9% reported having been enrolled for less than one 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 plan.) 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.
Thirteen percent of HMO enrollees reported being enrolled for less than 1 year, compared with the overall
Medicaid figure of 9%. Roughly 65% of HMO enrollees reported being enrolled between 1 and 5 years,
compared with 39% for the Medicaid overall. Twenty-two percent of HMO enrollees reported being
enrolled for 5 or more years, while the overall Medicaid figure was 52%.

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
Reported Number of Consecutive edad Me Medicaid MediPass MediPass MPN: MPN:
Overall HMO d d P PSN
Months in Medicaid (weighted) (eig ) FFS Choice No Choice NetPass PhyTrust
(weighted) (weighted)
Less than 1 year 8.9% 12.7% 8.7% 5.6% 6.7% 8.7% 7.5% 8.2%
At least 1 year, but less than 5 years 39.4% 65.1% 31.0% 38.1% 44.3% 48.7% 44.7% 50.8%
5 or more years 51.8% 22.2% 60.3% 56.3% 49.0% 42.7% 47.8% 41.0%
Reflects distribution among survey respondents
Sources: 1. Medicaid Managed Care Surveys, FY2006 and Medicaid Fee-for-Service Surveys, FY2006, Florida Center for Medicaid & the Uninsured.
2. Medicaid HMO Surveys, FY2006, State Center for Health Statistics










Less than one year E At least 1 year, less than 5 years Five or more years

Medicaid Overall 4: 4 51.8%

Medicaid HMO '2., 65'. 22.2%

Medicaid FFS 87 3 .% 60.3%

MediPass Choice 5.6 3.1% 56.3%

MediPass No Choice 6.7 44. 49.0%

MPN: NetPass '.S 42.7%

MPN: PhyTrust 7.. 47.8%

PSN 8.%. e :5 41.0%


0% 20% 40% 60% 80% 100%
Reflects distribution among survey respondents
Sources: 1. Medicaid Managed Care Surveys, FY2006 and Medicaid Fee-for-Service Surveys, FY2006, Florida Center for Medicaid & the Uninsured.
2. Medicaid HMO Surveys, FY2006, State Center for Health Statistics

49





































































50











Health Status














Fifty-nine percent of enrollees surveyed reported being in "fair" or "poor" health, while another 21%
reported being in "good" health, and 20% 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.

HMOs 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. However, these results cannot be statistically compared
with those of the other program components due to methodological considerations (see methodology
section for more details). No significant variations exist between the reports of enrollees in the various
Medicaid programs that could be compared statistically (all programs except HMOs).


Medicaid Medicaid
Self-Assessed Medicaid Medicaid Medicaid MediPass MediPassNo MPN: MPN:
Overall HMO PSN
Overall Health (weighted) (wei FFS Choice Choice NetPass PhyTrust
(weighted) (weighted)
Excellent or Very
Good 19.7% 30.1% 17.7% 14.9% 20.7% 18.7% 21.2% 14.6%
Good 21.1% 27.7% 18.7% 21.6% 23.4% 20.4% 25.3% 21.9%
Fair or Poor 59.2% 42.2% 63.6% 63.5%" 55.9% 60.9% 53.6% r 63.6%
Reflects distribution among survey respondents


Sources: 1.
2.


Medicaid Managed Care Surveys, FY2006 and Medicaid Fee-for-Service Surveys, FY2006, Florida Center for Medicaid & the Uninsured.
Medicaid HMO Surveys, FY2006, State Center for Health Statistics









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


Medicaid Overall

Medicaid HMO 42.2%

Medicaid FFS

MediPass Choice

MediPass No Choice

MPN: NetPass

MPN: PhyTrust

PSN


E 59.2%



63.6%

63.5%

55.9%

I 60.9%

53.6%

- 63.6%


] I I I I
0% 20% 40% 60% 80% 100%
Reflects distribution among survey respondents
Medicaid Managed Care Surveys, FY2006 and Medicaid Fee-for-Service Surveys, FY2006, Florida Center for Medicaid & the Uninsured.
Medicaid HMO Surveys, FY2006, State Center for Health Statistics

53


Sources: 1.
2.


Sel-Asessd Halt Sttu














A large portion of Medicaid enrollees reported that their mental health was less than "good." Forty-six
percent of enrollees surveyed reported being in "fair" or "poor" mental health, while another 24% 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 serious 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.1), 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.2

The reports of the various Medicaid program components varied significantly on this measure, with the
FFS and MediPass No Choice groups consisting of the largest portions of enrollees who are in "excellent"
or "very good" mental health, and the smallest portion who are in "fair" or "poor" mental health. The
MediPass Choice and MPN: NetPass groups had the highest portion of enrollees in "fair" or "poor" mental
health, and the lowest portion in "excellent" or "very good" mental health.
1 Source: Agency for Health Care Administration, Bureau of Medicaid Pharmacy Services, 2005
2 Source: Mental Health: A Report of the Surgeon General, 1999


Self-Assessed Overall Medicaid Medicaid
Overall HMO
Mental Health Overall HMO
(weighted) (weighted)
Excellent or Very Good 29.9%-
Good 23.7%
Fair or Poor 46.4%


Medicaid MediPass MediPass MPN: MPN:
PSN
FFS Choice No Choice NetPass PhyTrust

31.5% 23.9% 29.5% 23.3% 27.8% 24.9%
24.5% 19.6% 24.7% 22.8% 23.9% 22.5%
44.0% 56.5% 45.7% 53.9% 48.3% 52.6%


HMO Enrollees, who were surveyed separate
Sources: Medicaid Managed Care Surveys, FY 2006and Medicaid Fee-for-Service Surveys, FY 2006, Florida Center for Medicaid & the Uninsured.


Reflects
distribution
among
survey
respondents







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 46.4%

Medicaid HMO Question Not Asked

Medicaid FFS 44.0%

MediPass Choice


MediPass No Choice 45.7%

MPN: NetPass 53.9%

MPN: PhyTrust 48.3%

PSN 52.6%

0% 20% 40% 60% 80% 100%
Reflects distribution among survey respondents
Sources: Medicaid Managed Care Surveys, FY2006 and Medicaid Fee-for-Service Surveys, FY2006, Florida Center for Medicaid & the Uninsured

55


56.5%















A striking number of Medicaid respondents scored in the range of moderate to severe depression on the
2-item depression screener administered as part of this survey. Overall, 41% of Medicaid respondents
had screener scores indicative of moderate to severe depression. Fifty-nine percent had screener
scores indicative of no depression or mild depression.

The reports of the various program components differed significantly, with the PSN group being made up
of the largest portion of respondents in the moderate to severe range (49%), and the MediPass No
Choice group being made up of the smallest portion (36%).

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
Depression Screener Categories Overall
(weighted)
No Depression or Mild Depression Probable 59.1%
(PHQ Score 0-2)
Possibility of Moderate to Severe Depression
(PHQ Sco409%
PHQ Score 3+)


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


Medicaid MediPass MediPassNo MPN: MPN:
FFS Choice Choice NetPass PhyTrust

60.0% 55.2% 64.1% 52.5% 57.2% 51.0%

40.0% 44.8% 35.9% 47.5% 42.8% 49.0%


Reflects distribution among survey respondents


Sources: Medicaid Managed Care Surveys, FY2006 and Medicaid Fee-for-Service Surveys, FY2006, Florida Center for Medicaid & the Uninsured.








Percent whose score on the depression screener indicated that they could be
"moderately" to "severely" depressed:


Medicaid Overall

Medicaid HMO

Medicaid FFS

MediPass Choice

MediPass No Choice

MPN: NetPass

MPN: PhyTrust

PSN


40.9%


SQuestion Not Asked


*40.0%

E 44.8%

35.9%


I47.5%

42.8%

E 49.0%


I I I I I I
0% 20% 40% 60% 80% 100%
Reflects distribution among survey respondents
Sources: Medicaid Managed Care Surveys, FY2006 and Medicaid Fee-for-Service Surveys, FY2006, Florida Center for Medicaid & the Uninsured

57















Medicaid enrollees were asked several detailed questions about their health status and about existing
medical conditions. Sixty 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. Seventy 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 two of these items. However,
the magnitude of the differences was so small that policy implications are difficult or impossible to draw.


Medicaid
Functional Status Measure Overall
(weighted)
Health Limits Doing Moderate Activities 60.40/c
Has a physical or medical condition that interferes
with independence, participation in the community, or 53.10
quality of life
Has a physical or medical conditions that has lasted 70.2%
for at least 3 months (not including pregnancy)


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


Medicaid MediPass MediPass MPN: MPN: PSN
FFS Choice No Choice NetPass PhyTrust

61.5% 58.3% 56.5% 59.3% 51.9% 62.1%

52.7% 56.2% 50.8% 55.7% 48.2% 53.4%


70.8% 71.9% 64.1% 64.7% 59.9% 68.5%


Reflects distribution among survey respondents


Sources: Medicaid Managed Care Surveys, FY2006 and Medicaid Fee-for-Service Surveys, FY2006, Florida Center for Medicaid & the Uninsured.







-e l [ h N ] I Co n di tions th I nte I rfe I th I AESI r I If L i f I


Among Medicaid enrollees surveyed, regardless of program/plan:


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


0%


20%


40%


60.4%


53.1%


70.2%


60%


80%


100%


Does not include data from HMO Enrollees. Reflects distribution among survey respondents
Sources: Medicaid Managed Care Surveys, FY2006 and Medicaid Fee-for-Service Surveys, FY2006, Florida Center for Medicaid & the Uninsured


I I I I I





































































60








Experiences with Care
and Satisfaction





































































62










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 (83%). The MediPass No Choice group had the lowest
percentage of respondents with a personal doctor or nurse(71%).

It is important for the reader to note that most Medicaid patients in managed care choose a PCP or are
assigned a PCP by the system. Figures presented here are based on self-report, and, thus, are
subject to faulty respondent recall, or on alternate interpretations of question intent (i.e., different
interpretations of the phrase "personal doctor or nurse").
*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

Q" Do y havea Medicaid Medicaid
Q. Do you have a Medicaid MediPass MediPass MPN: MPN:
Overall HMO PSN
"personal doctor or nurse" FFS Choice No Choice NetPass PhyTrust
(weighted) (weighted)
Yes 80.1% 73.1% 83.2% 79.4% 71.4% 79.6% 74.5% 73.6%
No 19.9% 26.9%0 16.8% 20.6% 28.7% 20.4% 25.5% 26.4%
Reflects distribution among survey respondents
Sources: 1. Medicaid Managed Care Surveys, FY2006 and Medicaid Fee-for-Service Surveys, FY2006, Florida Center for Medicaid & the Uninsured.
2. Medicaid HMO Surveys, FY2006, State Center for Health Statistics







Pesoa Doto or Nus I


Percent with a personal doctor or nurse:


Medicaid Overall

Medicaid HMO

Medicaid FFS

MediPass Choice

MediPass No Choice
M=


S80.1%

73.1%

- 83.2%


U 79.4%
71.4%


M


Sources: 1.
2.


IPN: NetPass 79.6%

PN: PhyTrust 74.5%

PSN 73.6%

0% 20% 40% 60% 80% 100%
Reflects distribution among survey respondents
Medicaid Managed Care Surveys, FY2006 and Medicaid Fee-for-Service Surveys, FY2006, Florida Center for Medicaid & the Uninsured.
Medicaid HMO Surveys, FY2006, State Center for Health Statistics

65












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 (83%) 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 group had the largest portion of enrollees who
had been seeing their current PCPs for 5 or more years (48%), and the lowest portion who had been
seeing their current PCP for less than 1 year (16%). All of the plans performed well on this measure.


Medicaid
Length of Time Continuously Oera
Seeing Current PCP ra
(weighted)
Less than 1 year 16.7%,


At least 1 year but less than 5 years


39.40/


5 years or more 44.


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


Medicaid MediPass MediPass MPN: MPN:
PSN
FFS Choice No Choice NetPass PhyTrust
15.5% 20.7% 21.6% 16.4% 18.2% 18.1%
36.9% 48.5% 38.6% 56.2% 47.6% 44.2%
47.6% 30.9% 39.8% 27.4% 34.2% 37.8%


Reflects distribution among survey respondents


Sources: Medicaid Managed Care Surveys, FY2006 and Medicaid Fee-for-Service Surveys, FY2006, Florida Center for Medicaid & the Uninsured.









Percent of respondents reporting that they had been seeing their personal doctor or
nurse for 1 year or longer:
-1


Medicaid Overall

Medicaid HMO

Medicaid FFS

MediPass Choice

MediPass No Choice

MPN: NetPass

MPN: PhyTrust

PSN


83.3%


Question Not Asked


* 84.5%

79.3%

78.4%

S83.6%

I81.8%

181.9%


0% 20% 40% 60% 80% 100%
Reflects distribution among survey respondents
Sources: Medicaid Managed Care Surveys, FY2006 and Medicaid Fee-for-Service Surveys, FY2006, Florida Center for Medicaid & the Uninsured














Respondents who reported having switched PCPs since becoming enrolled in Medicaid (67% overall)
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, and 72% of adult commercial plan enrollees
reported thus. Fourteen percent of Florida Medicaid enrollees surveyed reported having "a small
problem" finding a PCP, and 14% reported it was "a big problem."

The seven plans differed significantly on this measure, with FFS and MPN: NetPass enrollees
reporting most favorably. In those groups, 73% to 79% of enrollees reported it was "not a problem" to
find a PCP. Among the other groups, 62% to 69% reported having no problems.

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


Medicaid Medicaid
Problem Getting Satisfactory e ald M I Medicaid MediPass MediPass MPN: MPN: P
Overall HMO PSN
Doctor or Nurse (weighted) (weighted) FFS Choice No Choice NetPass PhyTrust
(weighted) (weighted)
A big problem 13.5% 18.8% 8.9% 21.8% 22.1% 15.8% 19.4% 16.4%
A small problem 13.7% 15.4% 12.3% 16.4% 15.4% 11.5% 16.1% 14.8%
Not a problem 72.8% 65.8% 78.9% 61.7% 62.5% 72.7% 64.5% 68.8%
Reflects distribution among survey respondents
Sources: 1. Medicaid Managed Care Surveys, FY2006 and Medicaid Fee-for-Service Surveys, FY2006, Florida Center for Medicaid & the Uninsured.
2. Medicaid HMO Surveys, FY2006, 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


W 72.8%

65.8%

- 78.9%

61.7%

62.5%

I 72.7%

64.5%

I 68.8%


I I I I I I
0% 20% 40% 60% 80% 100%
Reflects distribution among survey respondents
Medicaid Managed Care Surveys, FY2006 and Medicaid Fee-for-Service Surveys, FY2006, Florida Center for Medicaid & the Uninsured.
Medicaid HMO Surveys, FY2006, State Center for Health Statistics

69


Sources: 1.
2.





































































70










Specialty Care













Respondents who reported that they had needed to see a specialist physician in the 6 months prior to
the interview (55%) were asked how difficult it had been to see that specialist. Their responses varied
greatly. Overall, more than two-thirds of respondents (71%) 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 16% reported it was "a big problem." So, while the
majority of respondents in Medicaid reported no problems seeing a specialist, a sizable minority 29%
- reported having a problem, and more than 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 (79%) 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. More than half
(56%) of respondents in the HMO group reported it was "not a problem" to find a specialist, and, of
those who had a problem, more than 60% reported it was "a big problem."
*Source: 2005 CAHPS Health Plan Survey Chartbook, National CAHPS Benchmarking Database


Medicaid
Difficulty Seeing Overall
a Specialist lighted)
(weighted)
A big problem 16.2%
A small problem 12.8%
Not a problem 71.1%


Medicaid
HMedicaid MediPass MediPass MPN: MPN: PSN
(weighted) FFS Choice No Choice NetPass PhyTrust
(weighted)
27.4% 8.7% 30.3% 28.6% 19.7% 30.1% 25.3%
16.6% 12.1% 10.9% 11.5% 16.2% 11.2% 15.2%
56.1% 79.1% 58.8% 59.9% 64.1% 58.7% 59.6%


Reflects distribution among survey respondents
Medicaid Managed Care Surveys, FY2006 and Medicaid Fee-for-Service Surveys, FY2006, Florida Center for Medicaid & the Uninsured.
Medicaid HMO Surveys, FY2006, State Center for Health Statistics


Sources: 1.
2.










Q. In the last 6 months, how much of a problem, if any, was it to see a specialist that
you needed to see?


SA Problem


* Not a Problem


Medicaid Overall

Medicaid HMO

Medicaid FFS

MediPass Choice

MediPass No Choice

MPN: NetPass

MPN: PhyTrust

PSN


I I I I I I
0% 20% 40% 60% 80% 100%
Reflects distribution among survey respondents
Medicaid Managed Care Surveys, FY2006 and Medicaid Fee-for-Service Surveys, FY2006, Florida Center for Medicaid & the Uninsured.
Medicaid HMO Surveys, FY2006, State Center for Health Statistics

73


Sources: 1.
2.





































































74










Other Types of Care













Respondents were asked if, in the 6 months prior to the interview, they had experienced an illness or
injury requiring immediate medical attention. Those who reported affirmatively (46%) were asked if
they had gotten that care as soon as they wanted it. Sixty-three percent of Medicaid enrollees overall
reported that they "always" got the care as soon as they wanted it. It is worthy of note that this figure
compares favorably with national CAHPS averages for Medicaid, commercial and Medicare plans.
Nationally, only 56% of adult Medicaid enrollees reported that they "always" got such care as soon as
they wanted it, while 62% of both commercial plan enrollees and Medicare plan enrollees reported
getting such care as soon as they wanted it. Among Florida Medicaid survey respondents, 16%
reported that they "usually" got care for illnesses or injuries as soon as desired, and fifteen percent
reported that they "sometimes" did. Six percent reported they "never" got that care as soon as they felt
necessary.

The reports of the seven Medicaid plans did not differ significantly on this measure.
*Source: 2005 CAHPS Health Plan Survey Chartbook, National CAHPS Benchmarking Database


Got Immediate Care for Medicaid Medicaid Medicad M s M s M :
Illness or Injury as Soon as Overall HMO Med dMe as ass PNP PSN
Wanted (weighted) (weighted) FFS Choice No Choice NetPass PhyTrust
Wanted (weighted) (weighted)
Never 6.1% 7.4% 4.8% 10.7% 4.8% 6.9% 8.3% 5.2%
Sometimes 15.2% 22.5% 12.6% 15.5% 19.3% 15.8% 18.5% 18.2%
Usually 16.1% 17.6% 15.6% 15.5% 18.7% 16.4% 19.1% 14.3%
Always 62.6% 52.5% 67.1% 58.3% 57.2% 61.0% 54.1% 62.3%

Reflects distribution among survey respondents
Sources: 1. Medicaid Managed Care Surveys, FY2006 and Medicaid Fee-for-Service Surveys, FY2006, Florida Center for Medicaid & the Uninsured.
2. Medicaid HMO Surveys, FY2006, State Center for Health Statistics










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

Medicaid Overall 62.6%

Medicaid HMO 52.5%

Medicaid FFS 67.1%

MediPass Choice 58.3%

MediPass No Choice 57.2%

MPN: NetPass 61.0%

MPN: PhyTrust 54.1%

PSN 62.3%


Sources: 1.
2.


I I I I I I
0% 20% 40% 60% 80% 100%
Reflects distribution among survey respondents
Medicaid Managed Care Surveys, FY2006 and Medicaid Fee-for-Service Surveys, FY2006, Florida Center for Medicaid & the Uninsured.
Medicaid HMO Surveys, FY2006, State Center for Health Statistics

77













Sixty-five 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 23% 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, 62% reported that they "usually" or
"always" got appointments as soon as desired. This suggests that many of 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 varied significantly on this measure. The PSN group had the
highest percentage (57%) of respondents reporting that they received urgent care the same day. The next
most favorable report was from the MPN: NetPass group, at 53%. The MPN: PhyTrust and MediPass No
Choice group had the lowest percentages of respondents reporting that they got urgent care the same day,
with figures of 46% and 47%, respectively.


Medicaid
Days Waiting To Get Care for Illness or
Overall
Injury that Required Immediate Care (e e
(weighted)
Same day 50.2%
1 day 15.0%
2 to 3 days 12.0%
4 days or longer 22.7%


Medicaid MediPass MediPass MPN: MPN: PSN
FFS Choice No Choice NetPass PhyTrust
50.9% 48.5% 46.5% 52.8% 46.3% 56.7%
15.3% 15.2% 16.0% 5.6% 7.4% 10.7%
12.3% 10.5% 13.9% 8.5% 15.4% 5.3%
21.5% 25.7% 23.5% 33.1% 30.9% 27.3%


HMO Enrollees, who were surveyed separately, were not asked this question Reflects distribution among survey respondents
Sources: Medicaid Managed Care Surveys, FY2006 and Medicaid Fee-for-Service Surveys, FY2006, Florida Center for Medicaid & the Uninsured.









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


Medicaid Overall

Medicaid HMO

Medicaid FFS

MediPass Choice

MediPass No Choice

MPN: NetPass

MPN: PhyTrust


IQuestion Not Asked


65.2%



66.2%

S63.7%

S62.5%

58.4%

53.7%


PSN 67.4%

0% 20% 40% 60% 80% 100%
Reflects distribution among survey respondents
Sources: Medicaid Managed Care Surveys, FY2006 and Medicaid Fee-for-Service Surveys, FY2006, Florida Center for Medicaid & the Uninsured

79













Respondents were asked if, in the 6 months prior to the 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-one 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 and 45% of adult commercial enrollees reporting that they
"always" got such care as soon as they wanted it. Among Florida Medicaid survey respondents, 20%
reported that they "usually" got non-urgent care as soon as desired, and 17% reported that they
"sometimes" did. Three 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 and MPN:
NetPass populations having the highest percentages of enrollees reporting that they "always" received
non-urgent care as soon as they wanted it. The MediPass No Choice group had the lowest percentage
of respondents reporting that they "always" got non-urgent care as soon as desired, while the PSN
group had the highest percentage reporting that they "never" got care as soon as desired.

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

Medicaid Medicaid
Got Appointment for Non-Urgent Medicaid MediPass MediPass MPN: MPN: P
Overall HMO PSN
Health Care as Soon as Wanted (weighted) (weighted) FFS Choice No Choice NetPass PhyTrust
(weighted) (weighted)
Never 2.7% 5.3% 1.0% 4.3% 6.9% 4.2% 6.5% 7.6%
Sometimes 16.7% 19.9% 15.2% 16.5% 22.8% 18.1% 15.9% 21.7%
Usually 19.6% 21.9% 18.0% 23.8% 21.0% 14.8% 19.6% 17.7%
Always 61.0% 52.9% 65.9% 55.4% 49.3% 63.0% 57.9% 53.0%
Reflects distribution among survey respondents
Sources: 1. Medicaid Managed Care Surveys, FY2006 and Medicaid Fee-for-Service Surveys, FY2006, Florida Center for Medicaid & the Uninsured.
2. Medicaid HMO Surveys, FY2006, 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

Ml~l~ll ~ l rt


IV

Ml


Sources: 1.
2.


- 61.0%
S52.9%

- 65.9%

55.4%

49.3%


IrN: Netrass 63.0%

'N: PhyTrust 57.9%

PSN 53.0%

0% 20% 40% 60% 80% 100%
Reflects distribution among survey respondents
Medicaid Managed Care Surveys, FY2006 and Medicaid Fee-for-Service Surveys, FY2006, Florida Center for Medicaid & the Uninsured.
Medicaid HMO Surveys, FY2006, State Center for Health Statistics

81














More than three-quarters 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 13% 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, 54% reported that they "usually" or "always" got
appointments as soon as desired. This suggests that many of 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 FFS group
reported most favorably, with 90% of respondents indicating that they received non-urgent care
within two weeks of calling for an appointment, and only 10% 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, and 38% reporting that they waited longer than 2
weeks.


Days Waiting Between Making an Medicaid
Appointment and Seeing a Provider Overall
for Non-Urgent Care (weighted)
Same day 15.00/
1 to 7 days 60.30A
8-14 days 11.90/
15 days or longer 12.90A


Medicaid MediPass MediPass MPN: MPN:
PSN
FFS Choice No Choice NetPass PhyTrust
14.9% 15.9% 13.5% 14.6% 14.4% 15.8%
63.7% 47.6% 60.9% 56.6% 55.9% 36.8%
11.4% 14.1% 11.2% 11.3% 11.9% 9.0%
10.0% 22.5% 14.4% 17.5% 17.8% 38.4%


HMO Enrollees, who were surveyed separately, were not asked this question Reflects distribution among survey respondents
Sources: Medicaid Managed Care Surveys, FY2006 and Medicaid Fee-for-Service Surveys, FY2006, Florida Center for Medicaid & the Uninsured.










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


87.1%


Question Not Asked


90.1%


77.6%


185.7%

82.5%

82.3%


61.7%


I I I I I
0% 20% 40% 60% 80% 100%
Reflects distribution among survey respondents
Sources: Medicaid Managed Care Surveys, FY2006 and Medicaid Fee-for-Service Surveys, FY2006, Florida Center for Medicaid & the Uninsured

83












Respondents were asked if, in the 6 months prior to the interview, they had visited an emergency
room (ER) to get treatment for themselves. While most Medicaid respondents (63%) 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
ER Visits in 6 Months Prior veral Medicaid MediPass MediPass MPN: MPN: P
Overall HMO PSN
to Interview (weighted) FFS Choice No Choice NetPass PhyTrust
(weighted) (weighted) 35
None 62.7% 60.3% 63.9% 61.1% 58.2% 65.7% 68.8% 58.9%
1 19.9% 17.8% 20.8% 19.0% 20.2% 18.6% 14.9% 16.4%
2 or more 17.4% 21.9% 15.3%'r 19.8%r 21.6% 15.8%f 16.3% 24.7%


Reflects distribution among survey respondents


Medicaid Managed Care Surveys, FY2006 and Medicaid Fee-for-Service Surveys, FY2006, Florida Center for Medicaid & the Uninsured.
Medicaid HMO Surveys, FY2006, State Center for Health Statistics


Sources: 1.
2.










Q. In the last 6 months, how many times did you go to an emergency room to get
care for yourself?


Medicaid Overall

Medicaid HMO

Medicaid FFS

MediPass Choice

MediPass No Choice

MPN: NetPass

MPN: PhyTrust

PSN


One visit



19.
17.8

20.8%1

19.0


17




5

1


S15.8

S16.3%


0% 20% 40% 60% 80% 100%
Reflects distribution among survey respondents
Medicaid Managed Care Surveys, FY2006 and Medicaid Fee-for-Service Surveys, FY2006, Florida Center for Medicaid & the Uninsured.
Medicaid HMO Surveys, FY2006, State Center for Health Statistics

85


* Two or more visits


1.4%

1.9%

.3%

9.8%

21.6%

;%




24.7%


Sources: 1.
2.


ii














Respondents who reported needing care, tests, or treatment in the 6 months prior to the interview
(71%) were asked how difficult it was to get the needed care. Overall, 71% of respondents reported it
was "not a problem" to get that care in Medicaid, while 15% report a "small problem" and 15% 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
Problem Getting Care, Tests, edad M a Medicaid MediPass MediPass MPN: MPN:
Overall HMO PSN
or Treatments (we ed) (weighted) FFS Choice No Choice NetPass PhyTrust
(weighted) (weighted)
A big problem 14.8% 19.1% 12.8% 18.5% 13.1% 14.1% 17.3% 18.2%
A small problem 14.7% 18.3% 13.3% 14.9% 15.5% 17.1% 19.8% 16.0%
Not a problem 70.5% 62.6% 73.9% 66.7% 71.4% 68.8% 62.9% 65.8%

Reflects distribution among survey respondents


Sources: 1.
2.


Medicaid Managed Care Surveys, FY2006 and Medicaid Fee-for-Service Surveys, FY2006, Florida Center for Medicaid & the Uninsured.
Medicaid HMO Surveys, FY2006, State Center for Health Statistics








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


Medicaid Overall

Medicaid HMO

Medicaid FFS

MediPass Choice

MediPass No Choice

MPN: NetPass

MPN: PhyTrust

PSN

0

Sources: 1. Medicaid Managed Care Surve
2. Medicaid HMO Surveys, FY 20


E 70.5%

62.6%

U 73.9%

66.7%

I 71.4%

I 68.8%

62.9%

S65.8%


I I I I I
0/ 20% 40% 60% 80% 100%
Reflects distribution among survey respondents
ys, FY2006 and Medicaid Fee-for-Service Surveys, FY2006, Florida Center for Medicaid & the Uninsured.
06, State Center for Health Statistics
87












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 (34%) 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
one-half of respondents (51%) reported that delays were "not a problem," while just under one-quarter
(23%) indicated it was "a small problem," and slightly more than one-quarter (26%) 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 between the programs on this measure.

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


Medicaid / Medicaid
Delays in Approval for e H Medicaid MediPass MediPass MPN: MPN: P
Overall HMO PSN
Care, Tests, or Treatments (weighted) (weighted) FFS Choice No Choice NetPass PhyTrust
Approval Needed from
Health Plan for Care,
Tests, or Treatments 33.9% 47.9% 28.3% 39.6% 31.7% 42.2% 39.6% 38.9%
Delays While Waiting for
Approval from Program
A big problem 26.3% 25.6% 27.5% 25.0% 23.8% 23.6% 19.4% 26.5%
A small problem 22.5% 26.9% 18.8% 23.2% 32.1% 31.8% 29.1% 24.5%
Not a problem 51.3% 47.6% 53.8% 51.9% 44.1% 44.6% 51.5% 49.0%
Reflects distribution among survey respondents


Sources: 1.
2.


Medicaid Managed Care Surveys, FY2006 and Medicaid Fee-for-Service Surveys, FY2006, Florida Center for Medicaid & the Uninsured.
Medicaid HMO Surveys, FY2006, State Center for Health Statistics









QItelt monts how mAprobm if or are


Q. In the last 6 months, how much of a problem, if any, were
while you waited for approval from Medicaid?

A Big Problem m A Small Problem


Medicaid Overall

Medicaid HMO

Medicaid FFS

MediPass Choice

MediPass No Choice

MPN: NetPass

MPN: PhyTrust

PSN


0 0





rJ13 1, J/6
265 24.5%
I S S I 1



-SII
-SI


delays in health care



Not a Problem

51.3%

47.6%

53.8%

51.9%

44.1%

44.6%

51.5%

49.0%


I I I I I I
0% 20% 40% 60% 80% 100%
Reflects distribution among survey respondents
Medicaid Managed Care Surveys, FY2006 and Medicaid Fee-for-Service Surveys, FY2006, Florida Center for Medicaid & the Uninsured.
Medicaid HMO Surveys, FY2006, State Center for Health Statistics

89


Sources: 1.
2.













Medicaid enrollees were asked if they got any new prescriptions for medication or needed to refill any
prescriptions in the 6 months prior to the interview. Eighty-three percent of respondents overall responded
affirmatively. There was a statistically significant difference between the Medicaid programs on this
measure, with figures ranging from 85% of respondents from the FFS program reporting that they needed
a prescription, to only 74% 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 (65%) reported it was "not a
problem," while 19% indicated it was "a small problem," and 16% indicated it was "a big problem" to get
their prescriptions through Medicaid. There was no significant difference between the programs on this
measure.


Medicaid
Problem Getting Prescription Overa
Overall
Medications e
(weighted)
Got New Prescription or Refilled a
Prescription in 6 months Prior to
Interview 83.4%

How Much of a Problem for Enrollee to
Get Prescription from Medicaid
A big problem 16.3%
A small problem 18.6%
Not a problem 65.2%


Medicaid
HMO
weightedd)


Medicaid MediPass MediPass MPN: MPN:
PSN
FFS Choice No Choice NetPass PhyTrust


85.0% 80.1% 79.5% 75.0% 74.0% 79.7%



16.9% 15.1% 11.7% 18.2% 12.5% 14.6%
19.2% 17.1% 16.1% 15.2% 16.6% 16.7%
63.9% 67.8% 72.2% 66.7% 70.9% 68.7%


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

Sources: Medicaid Managed Care Surveys, FY2006 and Medicaid Fee-for-Service Surveys, FY2006, Florida Center for Medicaid & the Uninsured.









O bt ai in I i [g I Pr esc1p [lii Dr g [1hr I [1 [6


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


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


Medicaid Overall


Medicaid HMO Question Not Asked


Medicaid FFS


MediPass Choice

MediPass No
Choice

MPN: NetPass


MPN: PhyTrust


83.4%


85.0%


S80.1%


79.5%


75.0%


74.0%


79.7%


Medicaid Overall


Medicaid FFS


MediPass Choice

MediPass No
Choice


MPN: NetPass


MPN: PhyTrust


PSN


0% 20%


80% 100%


0% 20%
0% 20%


40% 60%


Reflects distribution among survey respondents

Sources: Medicaid Managed Care Surveys, FY2006 and Medicaid Fee-for-Service Surveys, FY2006, Florida Center for Medicaid & the Uninsured


65.2%


Medicaid HMO Question Not Asked


63.9%


I 67.8%


I 722%


66.7%


I 70.9%


68.7%


80%


100%















Overall, 19% of Medicaid enrollees surveyed indicated that they had needed treatment or counseling for
personal or family problems in the 6 months prior to the interview. There were significant differences in
the reports of the various programs on this measure, with the FFS group having the smallest percentage
of enrollees who needed treatment/counseling (17%), and the MediPass Choice group having the
largest percentage, at 27%.

Those who needed treatment or counseling were asked "how much of a problem, if any" they had in
obtaining these services through Medicaid. Sixty-two percent of respondents indicated it was "not a
problem," while 38% reported having a problem. Twenty percent reported having "a big problem" getting
this treatment or counseling through Medicaid. There was no significant difference between the
programs on this measure.


Medicaid
Problem Getting Mental/Behavioral
Overall
Counseling (weighted)
(weighted)
Enrollee Needed Treatment or
Counseling for Personal or Family
Problems in Last 6 Months 19.0%
How Much of a Problem for Enrollee to
Get Needed Treatment


A big problem


Medicaid
HMO
weightedd)


I 19.5%


IA small problem
Not a problem


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


Medicaid MediPass MediPass MPN: MPN:
PSN
FFS Choice No Choice NetPass PhyTrust


17.0% 26.7% 20.7% 24.9% 23.0% 22.0%


18.3% 22.9% 19.4% 18.8% 20.8% 20.3%
18.3% 24.0% 12.5% 11.8% 11.7% 23.0%
63.3% 53.1% 68.1% 69.4% 67.5% 56.8%


Reflects distribution among survey respondents


Sources: Medicaid Managed Care Surveys, FY2006 and Medicaid Fee-for-Service Surveys, FY2006, Florida Center for Medicaid & the Uninsured.


A4 1"









DI rificulty Obtalhining Mental ori Behavioral Helt Counsering


Q. In the last 6 months, did you need any treatment
or counseling for a personal or family problem?


Q. In the last 6 months, how much of a problem,
if any, was it to get the treatment or counseling
you needed through Medicaid?


* Yes


Medicaid Overall

Medicaid HMO

Medicaid FFS

MediPass Choice

MediPass No Choice

MPN: NetPass

MPN: PhyTrust

PSN


* No


8.0%


Question Not Asked


6,,







6 '.


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


*A Big Problem HA Small Problem Not

Medicaid Overall

Medicaid HMO Question Not Asked

Medicaid FFS

MediPass Choice

MediPass No Choice

MPN: NetPass

MPN: PhyTrust

PSN

0% 20% 40% 60%


a Problem

61.6%


63.3%

53.1%

68.1%

69.4%

67.5%

56.8%

80% 100%


Reflects distribution among survey respondents

Sources: Medicaid Managed Care Surveys, FY2006 and Medicaid Fee-for-Service Surveys, FY2006, Florida Center for Medicaid & the Uninsured





































































94











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.

A statistically significant difference was found between the programs on the measure of staff
courteousness, but the difference is 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 87% reporting that staff were "usually" or "always" helpful.


Medicaid / Medicaid/
Experiences with Medicaid MediPass MediPass MPN: MPN:
Doctor's Office Staff (w ed) (weighted) FFS Choice No Choice NetPass PhyTrust
(weighted) (weighted)
Office Staff at Doctor's Office
Were Courteous and Respectful
Never or Sometimes 8.9% 12.5% 7.1% 10.6% 11.3% 10.4% 12.5% 12.2%
Usually or Always 91.1% 87.5% 92.9% 89.4% 88.7% 89.6% 87.5% 87.9%
Office Staff at Doctor's Office
Were Helpful
Never or Sometimes 15.6% 20.3% 13.1% 18.7% 20.7% 16.4% 17.9% 20.6%
Usually or Always 84.4% 79.7% 86.9% 81.3% 79.4% 83.6% 82.1% 79.4%
Reflects distribution among survey respondents


Sources: 1.
2.


Medicaid Managed Care Surveys, FY2006 and Medicaid Fee-for-Service Surveys, FY2006, Florida Center for Medicaid & the Uninsured.
Medicaid HMO Surveys, FY2006, 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 Courteous and Respectful
Staff Usually or Always Helpful


Medicaid Overall

Medicaid HMO

Medicaid FFS

MediPass Choice

MediPass No Choice

MPN: NetPass

MPN: PhyTrust

PSN


9

87.8



89


S88.

87


11.1%

5%

92.9%

1.4%

,7%

1.6%

5%

3%


87.1


0% 20% 40% 60% 80% 100%
Reflects distribution among survey respondents
Medicaid Managed Care Surveys, FY2006 and Medicaid Fee-for-Service Surveys, FY2006, Florida Center for Medicaid & the Uninsured.
Medicaid HMO Surveys, FY2006, State Center for Health Statistics

97


Sources: 1.
2.


79.4% nn













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-six 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 87% 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 77% 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. The HMO and MediPass No Choice
groups had the lowest percentages of respondents reporting favorably on these measures individually.
Recall, however, that the performance of the HMO group cannot be statistically compared with that of
the other groups in this report (see methods section for more information).

Medicaid Medicaid
Communicating with Doctors and ea M Medicaid MediPass MediPass MPN: MPN:
Overall HMO PSN
Other Providers ee) (ee) FFS Choice No Choice NetPass PhyTrust
(weighted) (weighted)
Doctor or Other Provider "Usually"
or "Always" Listened Carefully 86.2% 80.3% 88.7% 83.6% 81.5% 88.1% 83.6% 87.6%
Doctor "Usually" or "Always"
Explained Things So That Patient
Could Understand 84.5% 81.3% 85.1% 87.4% 80.8% 84.9% 81.8% 85.6%
Showed Respect for What Patient
Said 87.1% 83.7% 89.1% 84.1% 80.1% 88.4% 84.7% 89.0%

Reflects distribution among survey respondents
Sources: 1. Medicaid Managed Care Surveys, FY2006 and Medicaid Fee-for-Service Surveys, FY2006, Florida Center for Medicaid & the Uninsured.
2. Medicaid HMO Surveys, FY2006, 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 77.0%

Medicaid HMO 71.8%

Medicaid FFS 79.6%

MediPass Choice 76.7%

MediPass No Choice 70

MPN: NetPass 77.2%

MPN: PhyTrust 73.5%

PSN 78.2%

0% 20% 40% 60% 80% 100%
Reflects distribution among survey respondents
Sources: 1. Medicaid Managed Care Surveys, FY2006 and Medicaid Fee-for-Service Surveys, FY2006, Florida Center for Medicaid & the Uninsured.
2. Medicaid HMO Surveys, FY2006, State Center for Health Statistics




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