Medicaid managed care in thirteen states

Area of Science:

• Health Policy
• Public Health
• Health Services Research

Background:

• Medicaid managed care is expanding nationwide.
• States aim to improve access and control costs through managed care.

Purpose of the Study:

• Examine the expansion of Medicaid managed care in thirteen states.
• Assess enrollment patterns, particularly for high-cost beneficiaries.
• Identify conflicts between cost-saving goals and provider protection.

Main Methods:

• Analysis of data from the Urban Institute's Assessing the New Federalism project.
• Review of Medicaid managed care enrollment trends in thirteen states.
• Qualitative assessment of state strategies and challenges.

Main Results:

• Despite significant enrollment growth, few elderly or disabled individuals are enrolled in Medicaid managed care.
• Cost-saving objectives frequently conflict with efforts to contract with mainstream insurance plans.
• Protecting safety-net providers presents challenges within managed care models.

Conclusions:

• Medicaid managed care expansion has not effectively included the most expensive beneficiary groups.
• Balancing cost containment with access to care and provider stability remains a key challenge.
• Further research is needed to optimize Medicaid managed care for diverse populations.