EXECUTIVE SUMMARY

In an effort to support the Administration’s Fatherhood Initiative, intended to strengthen the role of fathers in the American family, the Health Care Financing Administration (HCFA) through its Office of Beneficiary Services, Medicaid Bureau, provided funding for an outreach effort that focused on Medicaid fathers in rural Tennessee.  This project, consisting of three focus groups, was done in conjunction with the Tennessee Department of Health (DPH).  The focus groups were facilitated by staff from the Tennessee Valley Authority, a contractor in the region.  Previous efforts were conducted in urban Baltimore (refer to “Medicaid Urban Fatherhood Initiative Focus Groups; The Health Care Financing Administration; Baltimore, Maryland”, issued 1997), and into yet another aspect of fatherhood, with American Indian/Alaska Native Medicaid beneficiaries living in Hoonah, Alaska.

A series of three focus groups were conducted, comprised of custodial mothers of Medicaid children, custodial fathers of Medicaid children, and fathers living apart from the Medicaid children.  Questions were designed to provide information by:

• defining the fathers’ role in providing health care and making health care decisions for children,
• identifying barriers to fathers’ involvement in these processes, and receiving input from fathers for developing recommendations to overcome these barriers,
• determining the level of knowledge possessed by Tennessee Medicaid beneficiaries regarding eligibility and program benefits,
• determining how rural beneficiaries utilize their Medicaid benefits, and if they have problems accessing the system, and
• determining the best vehicle(s) the State can utilize to provide Medicaid program information to its beneficiaries.

The Tennessee Department of Public Health (DPH) made appointments, mostly through the mail, with approximately 45 Medicaid fathers and mothers.  Unfortunately, most appointments could not be confirmed, due to many of the beneficiaries not having telephones in their homes.  Despite the financial incentive of a $50 honoraria and a dinner meal served at each group, attendance, especially for the two fathers’ groups, was disappointingly low.  A total of 17 beneficiaries attended the three groups.  The majority of participants were white females (8), with six white males, one African­American non­custodial father, and two African­American custodial mothers.  An unfortunate dynamic within the Medicaid population is that most often, absence (and non-support) of the father leads to Medicaid eligibility.  Getting some of the fathers, not involved with their families’ day to day lives, to participate in these focus groups proved to be extremely difficult.

All participants had some prior experience with either the traditional Medicaid or managed care (TennCare) programs (see discussion under following section entitled “TennCare Overview).  The level of knowledge varied among the participants, but clearly, the custodial mothers had the most knowledge and experience.  It was noted, however, that few respondents had a clear understanding of their Medicaid benefits through TennCare.

Access to care was the predominant problem experienced by most participants.  It was reported that there was a lack of qualified providers within close proximity of the beneficiaries homes.  While it is the “rule” of TennCare that providers must be either within 30 miles, or 30 minutes away from beneficiaries’ homes, we received numerous reports that this rule was not adhered to.  One beneficiary, for example, reported that she was required to travel 2 hours for OB-GYN services, in another county, because there were no OB-GYN providers within 30 miles of her home.

The non-custodial fathers focus group participation indicated that they played only a small role in their children’s health care, and preferred the children’s mothers to assume that role.  It was clear from the mothers’ group discussions that relations between the mothers and fathers were often strained, and this was most often reflected by the mothers’ comments that all they wanted the father to do was help with some financial support.

Another commonality among all beneficiaries interviewed was the expressed belief that their providers had a bad attitude towards their TennCare patients because they were on Medical Assistance, and did not provide them with the attention and care they deserved.  The beneficiaries also expressed a desire to choose their own doctors, and not be assigned to Plan doctors.

While more participation by Medicaid fathers would have been desirable, we believe we have gained additional, valuable insights regarding the informational needs of rural Medicaid beneficiaries and their perceptions of the services they receive through the Medicaid program.