Making Tough Choices: Adults with Disabilities Prioritize Their Medi-Cal Options

Publication Date: November 2004

Publisher: California HealthCare Foundation

Author(s): Marjorie Ginsburg; Kathy Glasmire

Research Area: Health

Type: Report

Coverage: California

Abstract:

If adults with disabilities could prioritize their Medi-Cal coverage options, what trade-offs would they make? Is broad coverage more important to them than avoiding cost sharing? Is improving access to physicians more important than maintaining eligibility levels? With support from CHCF, Sacramento Healthcare Decisions (SHD) engaged Medi-Cal beneficiaries in a project to identify their individual and collective health care priorities. SHD had adult Medi-Cal beneficiaries with disabilities use "Choosing Healthplans All Together" (CHAT), a computerized tool and interactive group process developed by physician-ethicists at the National Institutes of Health and the University of Michigan. While CHAT has been tested extensively with privately insured populations, this effort marked its first use by people who receive health care through a government program. CHAT participants designed their Medi-Cal benefits by making choices from 14 categories of services, each with two or three tiers of benefits. Participants were given a limited budget and had to prioritize the services they regarded as most vital, which required them to make trade-offs among the types of services covered; the level of coverage for each service; and the individuals who received coverage. The Medi-Cal CHAT sessions were conducted in spring 2004 with 131 participants in 12 separate groups held in urban, suburban, and rural locations throughout the state. One key finding that reflects the choices made by participants, as well as the dominant views conveyed during the group discussions, is the importance of maintaining a full range of Medi-Cal services that affect all Medi-Cal beneficiaries with disabilities. The findings also found important similarities and differences between Medi-Cal and privately insured CHAT participants related to the role of health care in their lives and their health care priorities.