Cynthia  Rocha
The University of Tennessee
Henson Hall
Knoxville TN 37996
USA
Phone: 865-974-7513
Email: crocha@utk.edu

Andrea McCarter
The University of Tennessee
Henson Hall
Knoxville TN 37996
USA
Phone: 865-974-7513
Email: akmccarter@aol.com

Purpose:
Research supports that managed care contributes to a reduction in inpatient costs and an increase in outpatient service use.  This study discusses the findings of a qualitative analysis of Medicaid managed care recipients on the barriers and enabling factors to obtaining mental health services.

Methods:
This study was conducted in the summer of 1997, three and a half years after TennCare was implemented by interviewing a purposive sample of people who had contacted a managed care advocacy organization.  Thirty-six of the forty people contacted completed in-depth interviews for a completion rate of 90%.  Two raters performed content analyses to increase interater reliability.  The content analyses were conducted by breaking down the responses into the following thinking units: conditions, interactions, strategies and tactics and consequences.

Results:
Recipients reported many conditions that resulted in poor mental health care.  Access to services, referral problems and quality of care emerged as themes and remained a primary concern as contributing to poor care. Also, discussed were problems concerning deductibles, spend down requirements, and being denied services provided long distances from where people lived. Interactions included: client/ physician, client/ mental health specialist, client/ managed care system, client/ state caseworker. Strategies and tactics used by recipients included coping by remaining silent, accepting poor service, attempts to improve access to care by registering formal complaints, or filing grievances. Many recipients are not knowledgeable of the grievance process or their right to appeal. Consequences included confusion, frustration and themes of disempowerment.

Implications for Social Work:
Social workers who are providing clinical services in managed care arenas need to be cognizant of the barriers their clients face in the mental health system. Social workers need to advocate for access to quality health care and empower clients to work toward change.