Understanding the Assignment in Medicaid and its Impact on Health Equity

“(on health) I see no alternative to direct action and creative nonviolence to raise the conscience of the nation.” March 25, 1966, convention of the Medical Committee for Human Rights (MCHR). - Dr. Martin Luther King. Jr.

Making a one-hour doctor's appointment can cost some a full day's pay. Building the courage to call and schedule an appointment, request unpaid time from work, should one be employed, and bear the cost of travel to and from is no insignificant feat. For the most part, Medicaid members are assigned to providers they didn't choose, nor are they near. The lack of choice in selecting their health plans and doctors due to the current auto-assignment process restricts patient autonomy and has broader implications for health equity.

In many states, Medicaid-eligible members are automatically assigned to a health plan and, subsequently, to primary care providers within that plan's network. This auto-assignment is often based on factors such as geographic location and provider availability, with little to no input from the members. The privilege and opportunity to choose one's doctor can be an essential aspect of patient-centered and proactive care. Members from underserved communities, who make up a significant portion of Medicaid enrollees, are disproportionately affected by lack of choice, potentially leading to disengagement and poorer health outcomes.

Auto-assignment denies Medicaid members this choice, and they often feel constricted. Consequently, this can affect their comfort level and trust in their healthcare providers and the healthcare system. Disempowering experiences, such as the absence of choices in care, can manifest as a sense of powerlessness and a pejorative belief that one cannot make better health choices due to systemic barriers and a complex healthcare system that projects indifference to one's specific needs.

Lack of accessible information, limited choices in healthcare providers, and bureaucratic complexities hinder the formation of strong doctor-patient relationships as patients might feel disconnected from a provider they did not personally choose. For example, lower literacy rates and more clarity and transparent information about health and healthcare options contribute to feeling overwhelmed when making health-related decisions. Navigating the healthcare system is daunting. Populations struggling with economic hardships, perceived indifference, bias, and access restrictions foster impressions of being trapped in an ever-changing impossibility.

Lastly, the execution of this process inadvertently perpetuates health inequities. Specifically, designated care providers might not always best fit the member's specific and often complicated healthcare needs, cultural background, or language preferences. Narrower provider networks within Medicaid exacerbate these concerns.

Health plans, providers, and partners can collaborate to regularly incorporate patient feedback into healthcare policies and practices to support quality and outcome evolution in the system overall. Successfully locating and engaging the hardest-to-reach members and moving them into care coordination help bolster a member's sense of autonomy and build stronger relationships with providers. Providing members with clear, straightforward information about their healthcare options is crucial. This could include simplified guides to understanding Medicaid benefits and means to access available healthcare services more effortlessly.

Community partner collaboratives can streamline and bolster individuals' abilities to navigate the healthcare system. Often acting as extensions for health plans into the community, collaborative partnerships assist members with understanding health insurance, scheduling appointments, and even accompanying members to visits where needed.

Seasoned and trained community engagement specialists are effective in empathetic communication that significantly empowers members. When members feel heard and understood, they are more likely to engage in their health plans, better utilize their benefits, and make healthier decisions.

Making preventive care more accessible encourages members to manage their health proactively. This includes regular screenings, vaccinations, and participation in educational healthy living programs. Every member has unique health needs.

Using data and advanced analytics to develop a more refined auto-assignment process that considers geography, patterns of utilization, specific medical histories, or conditions of individuals will lead to more adequate and appropriate care. Building more sophisticated assignment models can facilitate how members experience healthcare and change the utilization of services.

Working to change the dynamic to where members are vibrant and active participants rather than passive recipients in their healthcare promotes engagement and more promising health outcomes.