Dissertations & Theses (Open Access)

Date of Award

Summer 8-15-2025

Degree Name

Doctor of Philosophy (PhD)

Advisor(s)

GRETCHEN GEMEINHARDT, PHD, MBA

Second Advisor

AANAND NAIK, MD

Third Advisor

SUSAN TORTOLERO EMERY, PHD

Abstract

Background: The COVID-19 pandemic disrupted the United States’ safety net program, Medicaid, for low-income individuals affecting access to care, increasing enrollment, and requiring new approaches to care delivery. The literature shows that beneficiaries’ personal characteristics influence their healthcare experience. This study investigated the association between Medicaid beneficiary characteristics and experience with their Medicaid health plan, examined if COVID-19 negatively impacted experience, and tested if COVID-19 moderated the relationship between beneficiary characteristics and experience.

Methods: The research sample was 76,976 adult Medicaid beneficiaries who voluntarily completed the annual Consumer Assessment of Healthcare Providers and Systems (CAHPS) health plan surveys in 2018 through 2021. First, we used logistic regression to analyze if adult Medicaid beneficiary characteristics (sex, race, ethnicity, age, education, and health status) were associated with better experiences (rating of healthcare experience, rating of personal doctor, rating of health plan, doctor communication, and customer service). Then, we used logistic regression to determine whether adult Medicaid beneficiaries had less favorable experiences during COVID-19. Last, we tested if COVID-19 moderated the relationship between the characteristics and experience measures using the Likelihood-Ratio test.

Results: Our findings indicate that there are significant associations between beneficiary characteristics and experience measures. We found that all the characteristics, except ethnicity, impact beneficiary experiences. In addition, there were significant positive, as opposed to negative, associations between COVID-19 and the experience measures. Lastly, COVID-19 had no significant impact on the relationships between any of the adult Medicaid beneficiary characteristics and the ratings of the experience measures.

Conclusion: COVID-19 was a major disruption to healthcare delivery. Our study supported previous findings on the association between beneficiary characteristics, except ethnicity, and experience. Unexpectedly, COVID-19 was positively associated with most experience measures. Finally, COVID-19 did not moderate the relationships between beneficiaries’ characteristics and their experience with their Medicaid health plans. Additional studies are needed to understand the complex nature of COVID-19’s impact on beneficiary characteristics and their experience.

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