{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,2]],"date-time":"2025-08-02T16:24:14Z","timestamp":1754151854660,"version":"3.41.2"},"reference-count":41,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2025,3,14]],"date-time":"2025-03-14T00:00:00Z","timestamp":1741910400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Services Research"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To examine five enrollee\u2010reported experience of care metrics and assess enrollee, plan, and state characteristics associated with higher care ratings.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Setting and Design<\/jats:title><jats:p>We conducted a repeated cross\u2010sectional study using multivariable linear probability models and predictors that captured various enrollee, plan, and state characteristics. We evaluated five enrollee\u2010reported experience of care measures: being \u201calways or usually\u201d easy to get needed care (yes\/no), having a personal doctor (yes\/no), having timely access to a checkup or routine care (yes\/no), having timely access to specialty care (yes\/no), and healthcare rating (0\u201310).<\/jats:p><\/jats:sec><jats:sec><jats:title>Data Sources and Analytic Sample<\/jats:title><jats:p>We used enrollee\u2010level data for adults aged 18\u201364 from the National Committee on Quality Assurance (NCQA) Adult Medicaid Managed Care Member Experience Survey in 2018 and 2020.<\/jats:p><\/jats:sec><jats:sec><jats:title>Principal Findings<\/jats:title><jats:p>The study included 94,296 adults enrolled in 172 Medicaid managed care plans in 38 states and who responded to the member experience survey. Enrollees from racially and ethnically minoritized groups reported significantly worse experiences of care than non\u2010Hispanic White enrollees on all outcomes. Larger plan size was associated with a lower likelihood of timely access to checkups (\u22125.44 percentage points [PP] difference) but a higher likelihood of having a personal doctor (4.52 PP). Plan for\u2010profit status was associated with a lower likelihood of having access to needed care (\u22122.24 PP) or having a personal doctor (\u22124.07 PP). Enrollees in states with Medicaid managed care quality incentives for improving consumer experience of care were significantly more likely to report timely access to specialty care (5.16 PP).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Enrollees from racially and ethnically minoritized groups with poor health status report worse access to care, with characteristics such as for\u2010profit plan status and large plan size being associated with access to care. Strategies to improve care experiences may include targeted outreach, equity initiatives, and strengthening provider networks and availability.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1475-6773.14605","type":"journal-article","created":{"date-parts":[[2025,3,14]],"date-time":"2025-03-14T04:08:45Z","timestamp":1741925325000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Enrollee, Plan, and State Characteristics Associated With Experience of Care Among Adults in Medicaid Managed Care"],"prefix":"10.1111","volume":"60","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7417-6322","authenticated-orcid":false,"given":"Kevin H.","family":"Nguyen","sequence":"first","affiliation":[{"name":"Department of Health Law, Policy, and Management Boston University School of Public Health  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenneth","family":"Lim","sequence":"additional","affiliation":[{"name":"Department of Health Law, Policy, and Management Boston University School of Public Health  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4743-2014","authenticated-orcid":false,"given":"Sarah H.","family":"Gordon","sequence":"additional","affiliation":[{"name":"Department of Health Law, Policy, and Management Boston University School of Public Health  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8731-4210","authenticated-orcid":false,"given":"Megan B.","family":"Cole","sequence":"additional","affiliation":[{"name":"Department of Health Law, Policy, and Management Boston University School of Public Health  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,3,14]]},"reference":[{"key":"e_1_2_11_2_1","unstructured":"R.Garfield E.Hinton E.Cornachione andC.Hall \u201cMedicaid Managed Care Plans and Access to Care: Results From the Kaiser Family Foundation 2017 Survey of Medicaid Managed Care Plans \u201d2018 https:\/\/www.kff.org\/medicaid\/report\/medicaid\u2010managed\u2010care\u2010plans\u2010and\u2010access\u2010to\u2010care\u2010results\u2010from\u2010the\u2010kaiser\u2010family\u2010foundation\u20102017\u2010survey\u2010of\u2010medicaid\u2010managed\u2010care\u2010plans\/."},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2017.3174"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2018.0505"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/1475-6773.13106"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2021.01331"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1525-1497.2004.30235.x"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/1475-6773.00147"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.279.17.1377"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.37765\/ajmc.2022.89198"},{"issue":"1","key":"e_1_2_11_11_1","article-title":"Quality Management Strategies in Medicaid Managed Care: Perspectives From Medicaid, Plans, and Providers","volume":"78","author":"Gadbois E. A.","year":"2019","journal-title":"Medical Care Research and Review"},{"volume-title":"Medicaid Managed Care: Costs, Access, and Quality of Care","year":"2012","author":"Sparer M.","key":"e_1_2_11_12_1"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1177\/1077558708316930"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.282.18.1769"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.20.3.162"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/1475-6773.01172"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.298.14.1674"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/1475-6773.13000"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2020.5408"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.7326\/M14\u20100332"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamahealthforum.2021.0280"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2017.3766"},{"key":"e_1_2_11_23_1","article-title":"Quality Rating Systems in Medicaid Managed Care","author":"Rowan P.","year":"2021","journal-title":"Mathematica Policy Research"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamahealthforum.2022.2812"},{"key":"e_1_2_11_25_1","first-page":"1","article-title":"Assessing the Financial Health of Medicaid Managed Care Plans and the Quality of Patient Care They Provide","volume":"11","author":"McCue M. J.","year":"2011","journal-title":"Issue Brief (Commonwealth Fund)"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2017.7118"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1111\/1475-6773.12814"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0000000000001709"},{"key":"e_1_2_11_29_1","doi-asserted-by":"publisher","DOI":"10.1111\/1468-0009.12245"},{"key":"e_1_2_11_30_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2022.14791"},{"key":"e_1_2_11_31_1","unstructured":"Bailit Health \u201cMedicaid Managed Care Contract Language: Health Disparities and Health Equity \u201d2021 https:\/\/www.shvs.org\/wp\u2010content\/uploads\/2021\/02\/SHVS\u2010MCO\u2010Contract\u2010Language\u2010Healthy\u2010Equity\u2010and\u2010Disparities_February\u20102021.pdf."},{"key":"e_1_2_11_32_1","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0000000000001489"},{"key":"e_1_2_11_33_1","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0000000000000453"},{"key":"e_1_2_11_34_1","doi-asserted-by":"publisher","DOI":"10.1111\/1475-6773.12297"},{"key":"e_1_2_11_35_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamahealthforum.2021.0793"},{"key":"e_1_2_11_36_1","unstructured":"C. A.Grimm \u201cHigh Rates of Prior Authorization Denials by Some Plans and Limited State Oversight Raise Concerns About Access to Care in Medicaid Managed Care \u201dOEI\u201009\u201019\u201000350 July 2023 accessed September 22 2023 https:\/\/oig.hhs.gov\/documents\/evaluation\/3157\/OEI\u201009\u201019\u201000350\u2010Complete%20Report.pdf."},{"key":"e_1_2_11_37_1","unstructured":"E.HintonandJ.Raphael \u201c10 Things to Know About Medicaid Managed Care \u201dpublished March 1 2023 https:\/\/www.kff.org\/medicaid\/issue\u2010brief\/10\u2010things\u2010to\u2010know\u2010about\u2010medicaid\u2010managed\u2010care\/."},{"key":"e_1_2_11_38_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamahealthforum.2023.4929"},{"key":"e_1_2_11_39_1","unstructured":"America's Health Insurance Plans \u201cCare That Is Fair and Just: Improving Health Equity Through Medicaid Managed Care \u201d2021 https:\/\/www.ahip.org\/wp\u2010content\/uploads\/AHIP_IB\u2010HealthEquity\u2010MMC.pdf."},{"key":"e_1_2_11_40_1","unstructured":"Medicaid and CHIP Payment and Access Commission \u201cMedicaid's Role in Advancing Health Equity \u201dhttps:\/\/www.macpac.gov\/wp\u2010content\/uploads\/2022\/06\/Chapter\u20106\u2010Medicaids\u2010Role\u2010in\u2010Advancing\u2010Health\u2010Equity.pdf."},{"key":"e_1_2_11_41_1","unstructured":"Centers for Medicare & Medicaid Services \u201cMedicaid Managed Care Enrollment Reports \u201dpublished August 2020 accessed February 28 2024 https:\/\/www.medicaid.gov\/medicaid\/managed\u2010care\/enrollment\u2010report\/index.html."},{"key":"e_1_2_11_42_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamahealthforum.2023.3931"}],"container-title":["Health Services Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/1475-6773.14605","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,21]],"date-time":"2025-07-21T03:17:06Z","timestamp":1753067826000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/1475-6773.14605"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,14]]},"references-count":41,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2025,8]]}},"alternative-id":["10.1111\/1475-6773.14605"],"URL":"https:\/\/doi.org\/10.1111\/1475-6773.14605","archive":["Portico"],"relation":{},"ISSN":["0017-9124","1475-6773"],"issn-type":[{"type":"print","value":"0017-9124"},{"type":"electronic","value":"1475-6773"}],"subject":[],"published":{"date-parts":[[2025,3,14]]},"assertion":[{"value":"2024-11-12","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-02-26","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-03-14","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e14605"}}