Journal of Immigrant and Minority Health
2019

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

McBride K.* , Bacong A.M. , Reynoso A. , Benjamin A.E. , Wallace S.P. , Kietzman K.G.
  • a Department of Health Policy and Management, UCLA Fielding School of Public Health, Campus Box 951772, Los Angeles, CA 90095-1772, United States, UCLA Center for Health Policy Research, Los Angeles, CA, United States
  • b UCLA Center for Health Policy Research, Los Angeles, CA, United States, Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, United States
  • c UCLA Center for Health Policy Research, Los Angeles, CA, United States
  • d Department of Social Welfare, UCLA Luskin School of Public Affairs, Los Angeles, CA, United States
  • e UCLA Center for Health Policy Research, Los Angeles, CA, United States, Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, United States
  • f UCLA Center for Health Policy Research, Los Angeles, CA, United States, Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, United States

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. © 2019, Springer Science+Business Media, LLC, part of Springer Nature.

Author Keywords

immigrants Medicare Dual-eligible beneficiaries Medicaid Integrated care

Index Keywords

Medicare California immigrant medicaid decision making health care policy consumer Article interview human adult grounded theory
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85069877118&doi=10.1007%2fs10903-019-00922-5&partnerID=40&md5=6e9cec5b6da53c34cc0bc82a4729fd29
DOI: 10.1007/s10903-019-00922-5
ISSN: 15571912
Original Language: English