Medicaid managed care in Iowa: Experiences of older adults and people with disabilities.

BACKGROUND: A growing number of states are turning to managed care arrangements to provide care to senior and disabled Medicaid beneficiaries. Despite their complex care needs, very little is known about the experience of these individuals in managed care. OBJECTIVE: To document experiences of a sample of aged and disabled Medicaid beneficiaries receiving long-term services and supports through managed care in Iowa and to assess whether these experiences changed over time. METHODS: A purposive sample of 49 aged and disabled beneficiaries enrolled in one of seven HCBS waivers in Iowa was recruited in 2017. Telephone surveys were conducted in 2017 and 2019. A conventional content analysis was used to generate themes, which were then ranked by frequency proportions. Thematic frequencies were compared across waves among repeat respondents. RESULTS: Content analysis yielded seven themes in the following areas: system navigation; service approvals; provider relations; customer service; case management; perception of Iowa's transition to managed care; and oversight. Concerns with service approvals was the most frequently reported theme and within this, issues related to changes in approved services or hours and quality of newly approved services comprised the largest number of references. Beneficiary concerns appeared to grow over time among respondents participating in both survey interview waves. CONCLUSION: The results of this study point to serious and persistent concerns related to access and quality of care under managed care for at least some HCBS waiver participants in Iowa, underscoring the need for a comprehensive evaluation of the program.

Rural pharmacy closures: implications for rural communities.

Retail pharmacies provide essential services to residents of rural areas and serve many communities as the sole provider of pharmacist services. Losing the only retail pharmacy within a rural community (census designated city), and within a 10 mile radius based on driving distance ("sole community pharmacy"), may affect access to prescription and over-the-counter drugs and, in some cases, leave the community without proximate access to any clinical provider. This policy brief documents the closure of local retail pharmacies in which the pharmacist was the only clinical provider available in the community at the time the pharmacy closed. Characteristics of the community and the retail pharmacy are described. The findings may suggest future policy actions to minimize the risk or mitigate the negative consequences of pharmacy closures. Key Findings. (1) Between May 1, 2006, and October 31, 2010, 119 sole community pharmacies closed. (2) Of those 119 pharmacies, 31 were located in rural communities with no other health professionals or clinical providers. (3) In 16 states, at least 1 community lost a sole community retail pharmacy, and there was no other pharmacy within 10 miles (actual driving distance). (4) Of the 31 pharmacy closures in communities with no other providers, 17% were located in remote rural areas designated with a Rural-Urban Commuting Area (RUCA) score of 10 or higher. Such a score means that, on average, 60 minutes of travel time is required to reach an urbanized area, and 40 minutes is required to reach a large urban cluster of 20,000 population or more.

Causes and consequences of rural pharmacy closures: a multi-case study.

Local rural pharmacies provide essential pharmacy and clinical services to their communities. Pharmacists play a critical role in the continuum of care for rural residents, and the loss of a local pharmacy may impact access to prescription drugs and clinical care. This policy brief identifies factors that contributed to the closing of six pharmacies and describes how the affected communities adapted to losing locally based services. Key Findings. (1) Five out of the six pharmacies studied closed due to retirement and/or difficulties in recruiting a successor. (2) In five of the six communities, residents now either drive to the nearest pharmacy or use mail-order to receive their prescriptions and, in some instances, receive their prescriptions through a courier service from a pharmacy in a nearby town. (3) Access to pharmacy services in these communities is of most concern for individuals with limited mobility and those who lack a support system that can pick up and deliver their prescriptions (e.g., the elderly and people with acute conditions).