The Views of Older Adults on Medicaid Reforms are Critical

Objectives: Medicaid reform plans in several US states contain elements that are likely to decrease coverage and access while increasing health inequities that affect poor and vulnerable populations, including racial/ethnic minority older adults. These elements include: monthly premiums that increase over time; a volunteer or work requirement; the elimination of vision and dental benefits; and behavioral incentives that either reward or penalize beneficiaries. The objectives are to: (1) assess how the aforementioned elements of proposed Medicaid reform plans are experienced by older adults; and (2) identify the implications for their ability to access care through Medicaid.
Methods: As part of an ongoing study funded by the US National Institutes of Health to understand factors that serve as barriers to oral health and health care among racial/ethnic minority older adults, 24 focus groups were conducted with 194 African American, Dominican, and Puerto Rican participants aged 50 years and older living in northern Manhattan, New York, NY. Older adults were approached and screened for possible participation in the study at senior centers located throughout northern Manhattan.
Results: Participants reported problems with affording co-payments for care, complicated health and social issues, the need for vision and dental care close to home, and confusion about and stigmatization with Medicaid coverage. Hence, certain elements of proposed Medicaid expansion plans are in direct opposition, e.g., eliminating adult dental benefits would increase emergency room use and associated costs, thus further exacerbating the health and welfare of already disadvantaged and disabled older adults.
Conclusions: To meaningfully assess the policy implications of recently proposed Medicaid reform plans, the lived experiences and views of populations with Medicaid coverage ought to be taken into account. Government agencies can lend a helping hand by clarifying and simplifying Medicaid plans and sustaining benefits that older adults need to live healthy and dignified lives.