The impact of Medicaid managed care on the public health system in Arizona: case study

This article examines the impact of a statewide Medicaid managed care program, the Arizona Health Care Cost Containment System (AHCCCS), on the local public health system in Arizona. Based on interviews with current and former state and local public health officials, the authors describe public health concerns with capitated health care delivery systems that rely on gatekeeper systems to control utilization. The authors identified difficulties in gauging the extent of the problem, since neither public health nor managed care systems collect data on use of public health clinics by AHCCCS beneficiaries. Relationships between public health officials and managed care officials are characterized by tensions resulting from differing outlooks about access, eligibility, and the need for preventive health services. The report concludes with recommendations developed by the Association of State and Territorial Health Officials (ASTHO) Primary Care Committee on roles for state health agencies in ensuring development of appropriate managed care delivery systems for vulnerable populations.