Memoranda of understanding between Medicaid MCOs and public health departments

This evaluation research project was conducted to describe local perspectives on creating and implementing mandated memoranda of understanding (MOU) between Medicaid managed care organizations and local health departments (LHD), to provide insights into the strengths and limitations of MOU, and to share information on their use as tools for interorganizational service coordination.

A cross-sectional, qualitative and quantitative, self-administered, mailback survey was conducted with employees of MCOs and LHDs in California having experience in creating and/or implementing state-mandated MOU in nine service areas. Descriptive and qualitative results are reported.

The creation of MOU was facilitated by supportive leadership, previous collaborative experience, and the state mandate. The majority of respondents believed the MOU worked well to achieve coordination of services. MOU strengths and limitations were identified. The MOU were reported to have contributed to an increase in participation in four of six types of collaborative activities. Perceived quality of health care services for Medicaid participants improved with the MOU, but no impact on quality of public health services was reported. A majority (78 percent) supported a continuation of the mandated policy. Some organizations reported expanding the use of MOU beyond mandated areas.

Study respondents held generally positive perceptions of the strengths of MOU and supported continuation of the mandated MOU policy in California. Their experience demonstrates a capacity for MCOs and LHDs to work together on health care coordination issues despite the difficulties inherent in interorganizational collaboration.