Uncovering Barriers, Drivers, and Implications, and How it Shapes Healthcare Engagement
Trust in American healthcare is at its lowest level in decades.1, 2 Even in Illinois, where quality of care is an explicit priority within the Medicaid program,3 issues with trust affect preventive care and contribute to poorer health outcomes.4,5 Persistent disparities across racial and ethnic communities and low-income populations reinforce skepticism.6
For Meridian Health Plan of Illinois (Meridian), a Medicaid Managed Care Organization (MCO), addressing this issue is central to its mission of strengthening relationships with the communities it serves and addressing inequities while delivering care with dignity, respect, and cultural responsiveness.
To better understand how to overcome systemic distrust, Meridian launched an extensive quantitative study in late 2025. This builds on earlier qualitative research (including focus groups with community stakeholders, clergy, and Medicaid enrollees) to explore what trust means to Medicaid-eligible adults in Illinois.
The research reveals that while many Medicaid enrollees hold conditional confidence — baseline trust that can be quickly overridden by friction such as issues affecting decisions about utilizing healthcare — in their health plan, systemic and operational obstacles often prevent that confidence from translating into action (e.g., primary care provider visit for annual wellness exam, completion of cancer screening). Friction acts as a multiplier of distrust, determining whether intent becomes engagement in care.
Meridian is committed to closing gaps in access and quality while supporting whole-person health so individuals and communities can thrive. The organization recognizes the importance of addressing the breakdown in trust among Medicaid enrollees as a critical step to achieving these goals. Its research insights translate Medicaid enrollee experiences into clear indications of what drives their confidence, when friction breaks it, and what actions can help close the trust–behavior gap.
Research Overview & Methodology
Meridian partnered with a minority-owned firm based in Chicago with deep multicultural expertise to design, conduct, and analyze the research. The quantitative study examined how confidence influences drivers and barriers related to preventive care, vaccination, and mental healthcare, while also identifying key moments that build or erode confidence. The survey was translated into six languages and fielded across eight culturally distinct communities statewide to ensure robust racial and ethnic representation. Sixty-six percent of respondents came from communities of color, and 11 percent completed the survey in their preferred language.
Study at a Glance
- Year and design: 2025 quantitative online survey designed to validate and deepen insights from earlier qualitative work
- Sample: n=698 Medicaid-eligible adults (18+) in Illinois; focused sample of n=350 Medicaid-enrolled respondents
- Racial/ethnic diversity: Hispanic/Latino 17%, Black/African American 13%, Russian & Ukrainian 12%, Middle Eastern/MENA 12%, Indian Subcontinent 11.5%, Polish/Polish American 11%, White 11%, Chinese/Chinese American 11%
- Languages: Professionally translated into six languages (English, Spanish, Polish, Mandarin, Russian, and Arabic); 11% of respondents completed the survey in their preferred language
- Geography: Illinois residents across various zip codes
- Comparison: Behavior and barriers analyzed by current coverage type (Medicaid-enrolled vs. employer-sponsored vs. individually purchased plans)
- Limitations: Findings reflect self-reported experiences rather than clinical outcomes
The study examined healthcare engagement behaviors (preventive care usage, vaccination frequency); structural, administrative, and emotional barriers to care, trust in providers, health plans, and the system; motivational drivers for preventive, vaccination, and mental health behaviors; and differences by coverage context, race and ethnicity, and household characteristics.
Research Findings
The findings point to three insights that deepen understanding of how confidence influences healthcare engagement among a Medicaid-enrolled population. Overall, Meridian learned that even when people conditionally trust their health plan, barriers can limit proactive action.
Healthcare must meet people where they are. The research shows that confidence alone does not drive care. Friction, issues affecting decisions about utilizing healthcare, determines whether confidence turns into action.
Finding 1: Significant Trust–Behavior Gap in Preventive Care
The data reflects conditional confidence among the Medicaid population: trust that is often outweighed by the practical difficulties of navigating the plan. This dynamic is evident when examining the lower-friction experiences of those with employer-sponsored insurance.
Seventy percent of Medicaid-enrolled respondents reported being very or somewhat satisfied with their plan, and 59% described their plan as “trustworthy.” Yet nearly one-quarter (23%) felt neutral, and sizable minorities described their plan as hard to reach (18%), confusing (18%), impersonal (15%), or inconvenient (12%).
Only 49% reported seeking regular preventive care. Twenty-four percent visit only when they feel sick, 16% engage occasionally (every few years), and 11% rarely or never seek preventive care. This reactive pattern aligns with the finding that 61% said they only go to the doctor when something is wrong.
"I never call off work. If I'm not feeling well, I still go. I can't afford to take a day off. That's a day of pay I won't get back."
— Dominique (Medicaid Enrollee, qualitative survey respondent)
By comparison, Medicaid-eligible adults with employer-sponsored coverage show higher routine engagement and markedly lower friction. Coverage-type friction multipliers are clear: transportation affects about 67% of Medicaid-enrolled respondents often or always (versus 25% employer-sponsored); confusing paperwork affects around 55% of Medicaid respondents (versus 31% employer-sponsored); cost and coverage issues affect 52% of Medicaid respondents (versus 31% employer-sponsored).
Dominant structural and administrative barriers include waitlists or provider availability, lack of time, transportation issues, and confusing paperwork.
When asked what would motivate them to seek preventive care, Medicaid-enrolled respondents rated convenience and support-based resources, such as free rides and care coordinators, as most impactful.
Figure 1: The Friction Multiplier for Seeking Preventive Care
Medicaid-enrolled respondents show conditional trust in their health plan but face significant structural and administrative barriers to care.
What Medicaid Enrollees Believe | What Stops Medicaid Enrollees from Seeking Care |
|---|---|
Plan provides accurate info: 59% | Lack of time: 55% |
Plan helps access care: 57% | Waitlist or provider availability: 55% |
Plan treats them fairly: 55% | Transportation issues: 48% |
Plan is compassionate: 40% | Confusing paperwork: 48% |
Key Insight: Despite comparable levels of conditional trust, Medicaid-enrolled respondents show lower preventive care engagement than Medicaid-eligible respondents enrolled in private insurance, pointing to operational friction as the primary barrier. Addressing structural and administrative barriers will help increase engagement in preventive care, while boosting trust in healthcare and health plans. | |
Finding 2: Trust Functions Differently for Vaccinations and Mental Health
Low engagement levels in high-priority services like vaccination and mental health are driven by a complex interplay of information snags and a lack of cultural fit, illustrating that bridging the gap between coverage and care requires a strategy as diverse as the barriers Medicaid enrollees face.
For vaccination, behavior remains inconsistent. Only 32% of Medicaid respondents get vaccinated as often as recommended. Informational barriers are most prominent, where 55% cite confusion or too much information and 43% report distrust of healthcare providers as a barrier.
For mental health services, engagement is limited. Just 18% use services regularly, while 35% rarely or never access care. Relational barriers stand out, including finding a provider who “gets you,” distrust of mental health providers, and social stigma.
"We're navigating misinformation or trying to decipher what's fake news versus what's backed by science and research."
— Michelle (Community Leader, qualitative survey respondent
These differences underscore the need for differentiated strategies rather than a one-size-fits-all approach.
Figure 2: Trust Barriers Differ by Type of Health Service
Preventive care requires structural and administrative support. Vaccination requires informational clarity; mental health requires relational trust — each demands a distinct strategy.
Type of Health Service | Top Barriers | Trust-Building Strategy for Healthcare Stakeholders |
|---|---|---|
Preventive Care | Lack of time: 55% | Address structural and administrative barriers within the healthcare system through concrete interventions that materially mitigate challenges to accessing care – meeting members where they are in their lives and making their interactions with the Illinois Medicaid system (enrollment, providers, coverage, and services) as seamless as possible. |
Vaccination | Confusion: 55% | Counter misinformation with consistent, ongoing outreach — not one-time campaigns. Trusted messengers (e.g., community health workers, pharmacists, faith leaders) are more persuasive than institutional voices alone. Hyper-personalized, culturally relevant communications that anticipate specific fears outperform generic guidance. |
Mental Health | Finding a provider who “gets you”: 25% | Prioritize culturally resonant care by expanding provider diversity and investing in clinician training on cultural humility. Peer support models — where individuals with shared lived experience serve as recovery guides — are especially effective at bridging the relational trust gap. Behavioral health integration should be designed around normalization, not just access. |
Key Insight: Trust in preventive care requires addressing structural and administrative barriers; trust in vaccination requires informational clarity; and trust in mental health requires relational connection. MCOs need differentiated but complementary strategies to address these barriers and increase trust — not a one-size-fits-all approach. | ||
Finding 3: Cultural Relevance and Understanding as a Critical Opportunity
While Medicaid enrollees largely trust the technical reliability and security of their health plans, this confidence is undermined by a systemic lack of cultural relevance.
Medicaid respondents express the highest confidence in data protection and reliability (63%). But only 51% reported their health plan understands their culture and community background, which was the lowest-rated confidence factor tested. Additionally, in a separate question that asked respondents to select words to describe their health plan, just 10% described their health plan as culturally relevant. Across questions, respondents consistently gave the lowest ratings to cultural relevance and understanding.
A personal-versus-system trust gap is also evident, where 68% say they feel comfortable speaking to doctors or healthcare staff about their needs, yet 52% agree that the healthcare system treats people like them fairly.
Perceptions vary meaningfully by race and ethnicity. Black/African American and Hispanic/Latino respondents report the lowest agreement that the system treats people fairly, while Indian Subcontinent and White respondents report higher agreement. Hispanic/Latino and Middle Eastern respondents also show lower confidence in cultural sensitivity.
“When the doctor tries to speak Spanish, even if it isn’t perfect, it’s a sign of respect, that he cares about me.”
— Adriana (Medicaid Enrollee)
Figure 3: Plan Confidence by Dimension
Cultural understanding is the lowest performing dimension of confidence in health plans.
Plan Confidence Dimension | Confidence Level |
|---|---|
Protects personal information | 63% — Highest |
Provides accurate information | 59% |
Helps access care | 57% |
Treats people fairly | 55% |
Cultural understanding / sensitivity | 51% — Lowest |
Key Insight: Cultural understanding is most fragile dimension of confidence in health plans — a 12-point gap below the protection of personal information. . Closing this gap and demonstrating deep cultural understanding will help increase trust. Cultural relevance cannot be addressed through translation alone. It requires community co-design, culturally concordant providers, and a demonstrated commitment to understanding enrollee-lived experiences. | |
Figure 4: Cultural Trust Gaps by Racial/Ethnic Community
Confidence in fairness and cultural sensitivity varies meaningfully across Medicaid-enrolled communities in Illinois.
Community | Fairness | Cultural | Key Callout |
|---|---|---|---|
White | 61.4% | 59.1% | Highest on both |
Black/African American | 52.8% | 52.8% |
|
Chinese/Chinese American | 52.5% | 55.0% |
|
Hispanic/Latino | 50.9% | 41.8% | Low cultural fit |
Russian/Ukrainian | 48.7% | 51.3% |
|
Indian Subcontinent | 48.6% | 40.0% | Low cultural fit |
Polish/Polish American | 47.6% | 47.6% |
|
Middle Eastern/MENA | 38.1% | 59.6% | Lowest fairness |
Key Insight: Cultural trust gaps are not uniformly distributed across communities of color. Strategies must be community-specific, using personalized and culturally relevant messaging that goes beyond standard translation to reflect transculturation — how meaning, trust, and expectations evolve through lived experience. | |||
Top-2-Box = % of respondents within each community who selected the two most positive response options. Communities sorted by Fairness Top-2-Box, highest to lowest.
Research Implications: How Can We Earn Back Trust in Healthcare
The research demonstrates that trust is earned through concrete actions that reduce friction, provide clarity, and demonstrate cultural understanding. Needs differ by care type (preventive care, vaccination, mental health) and across racial and ethnic communities. The status quo is not an option.
The research identified four critical moments where trust erodes: coverage denials at the moment of need; access and network barriers that undermine care; administrative delays that signal indifference; and failures of respect, privacy, or being taken seriously.
When asked about their ideal experience, Medicaid respondents said care should be affordable, understanding of their circumstances, and simple enough to fit into everyday life.
Meridian’s Response: Taking Action to Turn Insights into Solutions That Matter Most
An across-the-board approach for all will fail. Solutions must recognize where Medicaid enrollees are in their care journey, and respond with relevant, friction-reducing support. The following examples of research-validated initiatives show how these insights can be translated into targeted approaches that address distinct barriers uncovered.
Reducing Friction to Close the Trust-Behavior Gap in Preventive Care
To directly address structural and administrative barriers, Meridian has expanded its primary care network by more than 1,200 providers across Illinois. To support Medicaid transportation benefits and respond to member feedback, Meridian has dedicated staff who actively monitor transportation challenges — including longer-distance trips — and work to identify more accessible providers, given the downstream impact of transportation barriers (e.g., missed appointments and readmissions). And Meridian provides personalized digital communication journeys in multiple languages that guide members step-by-step.
Through the Meridian MomCare program, culturally sensitive care and resources empower pregnant members. MomCare provides 1:1 support through a dedicated advocate during pregnancy and postpartum. Community partnerships extend access, such as a local doula provider in South Chicago (serving a large Black/African American population), a mobile pregnancy and postpartum care unit with OSF Healthcare in Central Illinois obstetric care deserts, and ongoing strategic efforts with the March of Dimes to bring maternal health information and resources to Chicagoland families where they live and work.
Building Trust Differently for Vaccination and Mental Health
Meridian delivers hyper-personalized preventive care journeys, which include vaccination education and community outreach to counter informational barriers. Behavioral health integration includes care manager support, provider training, telehealth and virtual care options. For example, an upcoming peer support initiative will leverage Meridian employees with lived experience to provide individualized guidance and peer-to-peer relationships. Complementing this work, Meridian’s foster care health plan, YouthCare HealthChoice Illinois, is sponsoring the nationally recognized Training for Adoption Competency program to strengthen clinicians’ ability to address the behavioral and developmental health needs of children in foster, adoptive, and kinship families.
Advancing Cultural Relevance and Understanding
Meridian is translating research insights into provider training and cultural competency materials across its network. Its Care in Our Community initiative delivers programs in members’ own neighborhoods, honoring local and cultural roots. Meridian member materials are available in English and Spanish (including the member handbook and redetermination resources, which are also available in Polish). Additionally, Meridian’s member handbook is available online in Arabic, Urdu, Tagalog, and Chinese.
To address gaps in social drivers of health tied to structural friction, Meridian’s Eat Well, Be Well nutrition initiatives work to address food insecurity, provide resources and wellness information. Examples include the Food is Medicine partnership with the Greater Chicago Food Depository to provide medically tailored meals that honor cultural preferences and the Meridian at the Market program, which offers farmers’ market vouchers for fresh produce. Meridian also offers culturally relevant education, including recipes for a variety of health conditions and dietary needs.
Looking Ahead
Trust fosters better communication, engagement, and health outcomes. Yet it is built slowly through consistent, visible action. For Medicaid enrollees, trust hinges on whether health plans reliably reduce friction and show up when needed.
“Building trust is everything. When our members know we’re here for them, it changes their health—and their lives.”
— Jeni (Care Coordinator)
The path forward requires shared responsibility. MCOs, providers, and communities must collaborate on barrier-reducing solutions and culturally resonant care. Meridian remains committed to these efforts as a trusted partner in advancing whole-person health for Illinois Medicaid enrollees.
About Meridian Health Plan of Illinois
Meridian Health Plan of Illinois, Inc. and its family of health plans provide government-sponsored managed care to families, children, seniors, and individuals with complex medical needs. This includes Meridian’s Medicaid Plan, YouthCare HealthChoice Illinois, Wellcare (Medicare Advantage plans), Wellcare By Meridian (Dual-Eligible Special Needs Plan), and Ambetter Marketplace plans. Meridian connects members to care and offers comprehensive services to support lifelong health and wellness. Meridian is a company of Centene Corporation, a leading healthcare enterprise committed to helping people live healthier lives.
References
1. eHealth. 2025 Healthcare Pulse Survey: eHealth Original Research March 2025. (PDF) Accessed February 12, 2026.
2. Adams, Katie. “Americans’ Trust in the Healthcare System Is Plummeting. How Can It Be Repaired?”. MedCity news. May 2025. Accessed February 23, 2026.
3. Illinois Department of Healthcare and Family Services. Comprehensive Medical Programs Quality Strategy (2024–2027) (PDF). Approved by the Centers for Medicare & Medicaid Services. Accessed March 2026.
4. Darden, M. E., & Macis, M. (2024, January). Trust and health care-seeking behavior (NBER Working Paper No. 32028). National Bureau of Economic Research.
5. Edelman. Trust: A Key Determinant of Health. March 2022. Accessed February 12, 2026.
6. Harvard T.H. Chan School of Public Health. (2023, February 7). Marginalized communities likely to distrust healthcare system, polling finds.