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Medicaid program choice, inertia and adverse selection.

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Kentucky's Medicaid managed care auto-assignment prioritized cost savings over enrollee-plan match quality. This led to adverse selection, with high-cost patients opting out, impacting plan viability without risk adjustment.

Keywords:
Adverse selectionInertiaManaged careMedicaid

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Area of Science:

  • Health Services Research
  • Public Health Policy
  • Health Economics

Background:

  • Kentucky implemented statewide Medicaid managed care in 2012, utilizing an auto-assignment system for enrollees.
  • The auto-assignment algorithm balanced cost-minimization and plan distribution, with minimal consideration for enrollee-plan quality matching.

Purpose of the Study:

  • To analyze the impact of Kentucky's Medicaid managed care auto-assignment algorithm on enrollee behavior and plan selection.
  • To investigate the role of health plan inertia and adverse selection in the Medicaid managed care market.

Main Methods:

  • Utilized administrative data from Kentucky's Medicaid managed care program.
  • Analyzed enrollee auto-assignment patterns, opt-out behaviors, and financial outcomes for health plans.

Main Results:

  • Auto-assignment heavily favored cost-minimization, with over half of enrollees remaining in even low-quality plans due to inertia.
  • High-cost enrollees were more prone to opt-out, leading to adverse selection and impacting plan profitability.
  • The highest quality plan experienced significant profit reduction due to attracting a disproportionate share of high-cost enrollees.

Conclusions:

  • Health plan inertia facilitated the cost-minimization strategy but masked quality issues.
  • Differential enrollee mobility and subsequent adverse selection pose risks to the long-term sustainability of Medicaid managed care markets.
  • Effective risk adjustment mechanisms are crucial for ensuring market stability and equitable plan performance.