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Healthcare Decision-Making Among Dual-Eligible Immigrants: Implications from a Study of an Integrated Medicare-Medicaid Demonstration Program in California

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Abstract

To improve the coordination of long-term services and supports for dual-eligibles (those with both Medicare and Medicaid), California created Cal MediConnect (CMC), an Affordable Care Act-authorized managed care demonstration program. Beneficiaries were “passively enrolled” into CMC, meaning they were automatically enrolled unless they actively opted out. The aim of this study was to examine differences in factors influencing the enrollment decisions of U.S. born and immigrant dual-eligible beneficiaries. To explore differences in decision-making processes, we conducted in-depth interviews with dual-eligible consumers (39 native and 14 immigrant) in Los Angeles County. Interviews were analyzed using a constructivist grounded theory approach. Our findings illustrate a heightened sense of vulnerability and disempowerment experienced by immigrant participants. Immigrant participants also faced greater challenges in accessing healthcare and eliciting healthcare information compared to U.S.-born participants. Understanding the diverse perspectives of dual-eligible immigrant healthcare decision-making has implications for health care reform strategies aimed at ameliorating disparities for vulnerable immigrant populations.

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References

  1. Derose KP, Escarce JJ, Lurie N. Immigrants and health care: sources of vulnerability. Health Aff (Project Hope). 2007;26(5):1258–68.

    Article  Google Scholar 

  2. Palloni A, Arias E. Paradox lost: explaining the hispanic adult mortality advantage. Demography. 2004;41(3):385–415.

    Article  PubMed  Google Scholar 

  3. Ro A. The Longer You Stay, the Worse Your Health? A critical review of the negative acculturation theory among Asian Immigrants. Int J Environ Res Public Health. 2014;11(8):8038.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Markides KS, Rote S. Immigrant health paradox. In: Scott RA, Kosslyn S, editors. Emerging trends in the social and behavioral sciences. Hoboken: Wiley; 2015.

    Google Scholar 

  5. Bustamante AV, Chen J, McKenna RM, Ortega AN. Health care access and utilization among US immigrants before and after the Affordable Care Act. J Immigr Minor Health. 2019;21(2):211–8.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Frogner BK, Spetz J, Parente ST, Oberlin S. The demand for health care workers post-ACA. Int J Health Econ Manag. 2015;15(1):139–51.

    Article  PubMed  Google Scholar 

  7. Buchmueller TC, Levinson ZM, Levy HG, Wolfe BL. Effect of the affordable care act on racial and ethnic disparities in health insurance coverage. Am J Public Health. 2016;106(8):1416–21.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Fox MH, Reichard A. Disability, health, and multiple chronic conditions among people eligible for both medicare and medicaid, 2005-2010. Prev Chronic Dis. 2013;10:E157.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Gimm G, Blodgett E, Zanwar P. Examining access to care for younger vs. older dual-eligible adults living in the community. Disabil Health J. 2016;9(3):431–8.

    Article  PubMed  Google Scholar 

  10. Centers for Medicare & Medicaid Services. About the Medicare-Medicaid Coordination Office. 2017. https://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/. Accessed 22 Dec 2017.

  11. Cal Duals. 2017. Coordinated Care Initiative. http://calduals.org/background/cci/. Accessed 22 Dec 2017.

  12. Graham CL, Liu P-J, Hollister BA, Kaye HS, Harrington C. Beneficiaries respond to California’s program to integrate medicare, medicaid and long-term services. Health Aff. 2018;37(9):1432–41.

    Article  Google Scholar 

  13. California Department of Health Services. 2019. Medi-Cal Managed Care Enrollment Report—December 2018. Sacremento, CA January 2, 2019.

  14. California Department of Healthcare Services. Cal MediConnect Performance Dashboard Metrics Summary—December 2018. Sacremento: California Department of Healthcare Servces; 2018.

    Google Scholar 

  15. California Department of Healthcare Services. 2019. Medi-Cal Managed Care Enrollment Report—December 2018. Sacremento, CA: California Department of Healthcare Services; January 2, 2019.

  16. Graham C, Kurtovich E, Stewart H, Liu M, Tlatelpa K, Wong A. Evaluation of Cal MediConnect: results of focus groups with beneficiaries. Berkeley: University of California; 2016.

    Google Scholar 

  17. Graham CL, Stewart HC, Kurtovich E, Liu P-J. Integration of Medicare and Medicaid for dually eligible beneficiaries: a focus group study examining beneficiaries’ early experiences in California’s dual financial alignment demonstration. Disabil Health J. 2018;11(1):130–8.

    Article  PubMed  Google Scholar 

  18. McBride K, Reynoso A, Alunan T, et al. Cal MediConnect enrollment: Why are dual-eligible consumers in Los Angeles County opting out. Los Angeles, CA: UCLA Center for Health Policy Research; 2017. p. 1–8.

  19. Craver GA, Gimm G, Hill KEV. Understanding care coordination experiences in a state medicaremedicaid financial alignment demonstration. J Health Hum Serv Admin. 2018;41(2):196–236.

    Google Scholar 

  20. James BD, Boyle PA, Bennett JS, Bennett DA. The impact of health and financial literacy on decision making in community-based older adults. Gerontology. 2012;58(6):531–9.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Chen J, Mullins CD, Novak P, Thomas SB. Personalized strategies to activate and empower patients in health care and reduce health disparities. Health Educ Behav. 2016;43(1):25–34.

    Article  PubMed  Google Scholar 

  22. Centers for Medicare & Medicaid Services. California Financial Alignment Demonstration (Cal MediConnect). 2019. https://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/FinancialAlignmentInitiative/California.html. Accessed 21 June, 2019.

  23. Charmaz K. Constructing grounded theory: a practical guide through qualitative research. London: Sage Publications Ltd; 2006.

    Google Scholar 

  24. Charmaz K. Constructionism and the grounded theory method. Handb Constr Res. 2008;1:397–412.

    Google Scholar 

  25. Strauss A, Corbin J. Discovery of grounded theory. Chicago: Adeline; 1967.

    Google Scholar 

  26. Ponce NA, Ku L, Cunningham WE, Brown ER. Language barriers to health care access among Medicare beneficiaries. Inquiry. 2006;43(1):66–76.

    Article  PubMed  Google Scholar 

  27. Pourat N, Wallace SP, Hadler MW, Ponce N. Assessing health care services used by California’s undocumented immigrant population in 2010. Health Aff. 2014;33(5):840–7.

    Article  Google Scholar 

  28. Johnson KR. The intersection of immigration status, ethnicity, gender, and class. In: Delgado R, Stefancic J, editors. The Latino/a Condition: A Critical Reader. New York: New York University Press; 1998. p. 376–80.

    Google Scholar 

  29. Nadash P, Day R. Consumer choice in health insurance exchanges: can we make it work? J Health Polit Policy Law. 2014;39(1):209–35.

    Article  PubMed  Google Scholar 

  30. Danis M, Solomon M. Providers, payers, the community, and patients are all obliged to get patient activation and engagement ethically right. Health Aff. (Project Hope). 2013;32(2):401–7.

    Article  PubMed Central  Google Scholar 

  31. Barnes AJ, Hanoch Y, Rice T. Determinants of coverage decisions in health insurance marketplaces: consumers’ decision-making abilities and the amount of information in their choice environment. Health Serv Res. 2015;50(1):58–80.

    Article  PubMed  Google Scholar 

  32. Politi MC, Kaphingst KA, Liu JE, et al. A randomized trial examining three strategies for supporting health insurance decisions among the uninsured. Med Decis Mak. 2016;36(7):911–22.

    Article  Google Scholar 

  33. Kunkel SR, Straker JK, Kelly E, Lackmeyer A. Community-based organizations and health care contracting. 2017.

  34. Super N, Kaschak M, Blair E. Health care and community-based organizations have finally begun partnering to integrate health and long-term care. In. Health Affairs Blog. Vol 2019: Health Affairs; 2018.

  35. Braveman P, Gottlieb L. The social determinants of health: it’s time to consider the causes of the causes. Public Health Rep. 2014;129(2):19–31.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Choi JY. Contextual effects on health care access among immigrants: lessons from three ethnic communities in Hawaii. Social Sci Med (1982). 2009;69(8):1261–71.

    Article  Google Scholar 

  37. Levy H, Janke A. Health literacy and access to care. J Health Commun. 2016;21(sup1):43–50.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Zallman L, Woolhandler S, Himmelstein D, Bor D, McCormick D. Immigrants contributed an estimated billion more to the Medicare Trust Fund than they took out. Health Aff. 2013;32(6):1153–60.

    Article  Google Scholar 

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Acknowledgements

The authors would like to extend gratitude to our community partners Anastasia Bacigalupo and Marge Moon from the Westside Center for Independent Living. We are also indebted to the CHOICE Study Community Advisory Group for their critical and informative feedback and guidance. The authors would also like to thank Tiffany Anne Alunan and Brenda Gutierrez for their assistance in translating, transcribing, and analyzing interviews. Finally, the authors especially thank all CHOICE Study participants for sharing their stories and perspectives with us.

Funding

Support for this research was provided by the Robert Wood Johnson Foundation (Grant No. 73052). The views expressed here do not necessarily reflect the views of the Foundation.

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Authors and Affiliations

  1. Department of Health Policy and Management, UCLA Fielding School of Public Health, Campus Box 951772, Los Angeles, CA, 90095-1772, USA

    Kaitlyn McBride

  2. UCLA Center for Health Policy Research, Los Angeles, CA, USA

    Kaitlyn McBride, Adrian M. Bacong, Ana Reynoso, Steven P. Wallace & Kathryn G. Kietzman

  3. Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, USA

    Adrian M. Bacong, Steven P. Wallace & Kathryn G. Kietzman

  4. Department of Social Welfare, UCLA Luskin School of Public Affairs, Los Angeles, CA, USA

    A. E. Benjamin

Authors
  1. Kaitlyn McBride
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  2. Adrian M. Bacong
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  3. Ana Reynoso
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  4. A. E. Benjamin
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  6. Kathryn G. Kietzman
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Correspondence to Kaitlyn McBride.

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McBride, K., Bacong, A.M., Reynoso, A. et al. Healthcare Decision-Making Among Dual-Eligible Immigrants: Implications from a Study of an Integrated Medicare-Medicaid Demonstration Program in California. J Immigrant Minority Health 22, 494–502 (2020). https://doi.org/10.1007/s10903-019-00922-5

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  • DOI: https://doi.org/10.1007/s10903-019-00922-5

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