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Related Experiment Videos

Risk selection among SSI enrollees in TennCare.

Steven C Hill1, Craig Thornton, Christopher Trenholm

  • 1Center for Cost and Financing Studies, Agency for Healthcare Research and Quality, Rockville, MD 20852, USA.

Inquiry : a Journal of Medical Care Organization, Provision and Financing
|October 10, 2002
PubMed
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Risk selection is a significant concern in Medicaid managed care for blind and disabled beneficiaries. This study found persistent risk selection among plans in Tennessee

Area of Science:

  • Health Services Research
  • Public Health Policy
  • Managed Care Economics

Background:

  • States enroll blind and disabled Supplemental Security Income (SSI) beneficiaries in Medicaid managed care.
  • These beneficiaries have complex, persistent health needs and require atypical services.
  • Risk selection occurs when plan enrollment and payments do not align with beneficiary healthcare needs.

Purpose of the Study:

  • To assess the extent of risk selection among managed care plans for SSI beneficiaries.
  • To analyze risk selection within Tennessee's Medicaid managed care program (TennCare) over its initial three years.

Main Methods:

  • Utilized claims data including pre-enrollment fee-for-service expenditures.
  • Analyzed data for Supplemental Security Income (SSI) beneficiaries in managed care.

Related Experiment Videos

  • Examined the first three years of the TennCare program.

    • Main Results:

    • Found substantial evidence of persistent risk selection among managed care plans.
    • Risk selection patterns were observed across multiple plans.
    • Results remained robust when using various risk selection measures.

    Conclusions:

    • Managed care plans exhibit persistent risk selection for SSI beneficiaries.
    • This highlights a critical issue in ensuring equitable care for vulnerable populations.
    • Further strategies may be needed to mitigate risk selection in Medicaid managed care.