Over 90% of Medicare and Medicaid Enrollees Experience Delays or Barriers to Care, According to Survey

A new survey from Cityblock Health and Ipsos revealed that 92% of those enrolled in both Medicare and Medicaid—or dual-eligible folks—face delays in care, confusion about coverage and difficulty accessing essential health services.

While researchers behind the survey expect this dual-eligible population to surpass 15 million by 2028, these findings point to the urgent need for more integrated and person-centered models of care.

Dual-eligible individuals must often navigate two separate health plans, each with different rules, benefits and provider networks.

According to the survey of 280 respondents, this process tends to lead to delayed care, confusion about coverage, and increased reliance on emergency services.

Cityblock President Mike Roaldi told Managed Healthcare Executive that the transition from Medicare-Medicaid Plans (MMPs) to Dual-Eligible Special Needs Plans (D-SNPs) represents a major inflection point.

The survey found that nearly one in four participants (24%) had to wait two weeks or more to see their primary care doctor, and 38% reported often waiting more than 30 minutes after arriving for an appointment.

One in five respondents said they found their healthcare difficult to access.

These access issues often led to delays or more costly alternatives: 42% reported visiting the emergency room or urgent care at least once in the past year due to dissatisfaction with their doctor, and 33% said they postponed care following a negative experience with the healthcare system.

In addition, 25% delayed care because they didn’t understand their health plan.

Mental health and social needs further complicate access to care.

It was also found that more than half of respondents (54%) said they experienced sadness at least monthly, 45% reported symptoms of depression and 42% said they often felt lonely.

Social determinants were also a factor.

For example, 28% reported transportation challenges and 69% said money was a daily struggle.

Toyin Ajayi, M.D., CEO and co-founder of Cityblock Health, said in a news release that these findings highlight the need for a different kind of healthcare experience.

“With nearly two in three dual-eligible patients struggling with their health daily, it's clear that more needs to be done to provide a trustworthy, effective, and longitudinal care experience for this population and prevent costly consequences like avoidable delays in care and unnecessary ER visits,” Ajayi said.

Cityblock’s care model focuses on delivering outcomes-based care tailored to individuals’ medical, behavioral and social needs. In 2024, the company served more than 100,000 Medicaid and dual-eligible members across seven states, partnering with community-based organizations.

Cityblock President Mike Roaldi told Managed Healthcare Executive that the transition from Medicare-Medicaid Plans (MMPs) to Dual-Eligible Special Needs Plans (D-SNPs) represents a major inflection point.

“I think we’ll continue to see a push for greater integration so that the Medicare and Medicaid benefits are aligned within a single payer,” Roaldi said. “The survey shows that confusion and delays are related, and having two payers covering different benefits with different networks adds to that confusion.”

Roaldi pointed out that dual-eligible folks often have multiple chronic and behavioral health needs, which makes “fragmented” care especially harmful.

When services are split across two systems, patients face more unmet needs, duplicative services and inconsistent communication between providers, he added.

“The complex and separate eligibility requirements, benefits, and rules for Medicare and Medicaid contribute to a fragmented and disjointed system of care,” Roaldi said. “That is mitigated from the member's perspective when a single plan covers both Medicare and Medicaid services.”

With all MMPs required to transition into D-SNPs, Roaldi said there are real opportunities for improvement—if health plans rise to the challenge.

“The good news is there has already been movement toward aligning the D-SNP and MMP requirements,” he noted. “Also, with fewer types of plans serving dual-eligible individuals, plans and providers can focus more of their attention and resources on care delivery.”

However, the transition to D-SNPs also comes with new risks.

Most members will have to actively choose their plan, making it essential for D-SNPs to offer real value and clear communication.

“D-SNP will represent a more heavily consumer-based orientation than MMPs,” Roaldi said. “This will present opportunities for D-SNP investment in supplemental benefits that can address seniors' social needs.”

He stressed that success will depend on robust partnerships and models that are built to serve complex populations.

“Without support for community-based, comprehensive care models like Cityblock, there is a risk of failing to advance outcomes within this vulnerable population,” Roaldi said. “The transition to D-SNPs, if supported by models like Cityblock, has the opportunity to shift the system toward more whole-person care experiences.”

The Cityblock and Ipsos survey makes clear that while some progress has been made, dual-eligible folks—particularly older adults—still face substantial barriers in accessing timely, coordinated care.