The potential impact of Medicaid reform on the health care-seeking behavior of Medicaid-covered children: a qualitative analysis of parental perspectives.

Objective: To assess perceptions and intended behaviors of parents of Medicaid-covered children regarding the potential impact of recent Medicaid reform on children's health care.

Methods: Qualitative study of parents of Medicaid-covered children in which parents were asked 40 questions to assess knowledge, beliefs, attitudes, and intended behaviors regarding Medicaid reform.

Results: Forty-nine parents were interviewed; their median age was 28 years. Ninety percent were African American, 64% were high school graduates, and 41% had children with chronic conditions. Parents were unaware of or confused by recent Medicaid reform, and a common theme was that the reform was unreasonable. Financial hardship was cited as a major potential consequence of reform, leading to increased use of government entitlement programs, greater debt, and bankruptcy. One mother stated, "What was the purpose of being on Medicaid if you could afford to pay for it?" Parents also expressed concerns about sacrifices they would have to make to pay copayments for their children. Major sacrifices included food, utility bills, clothing, taking additidnal jobs, working longer hours, and cutting back on parental medications. In response to copays and premiums, parents would defer needed preventive and sick care for children, rely more on charity care, and increase use of the emergency department (ED). Many parents expressed concerns that the reform would negatively impact overall family well-being.

Conclusions: Parents of Medicaid-covered children report that current Medicaid reform will result in increased financial and nonfinancial hardship, deferral of children's preventive and sick care, increased reliance on charity care, increased ED visits, and decreased health and well-being for children and families.