Managed Care Prevails As States’ Medicaid Health Care Delivery Method

imagingBiz | Managed care is now the prevailing method through which states deliver health care to Medicaid beneficiaries. However, key findings of a survey released September 13 by the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured (KMCU) indicate that states may not have the capacity to accommodate the spike in enrollment that is anticipated from health reform in 2014.

The survey, which describes state Medicaid managed care programs, their diversity, and how states monitor access and quality, also shows that two-thirds of low-income Medicaid recipients are enrolled in comprehensive managed care programs. The latter include risk-based managed care organizations (MCOs) and primary care case management programs.

Alaska, Wyoming, and New Hampshire were the only three states that did not have any managed care programs as of October 2010 when the survey was conducted, according to the report. Of individuals covered by Medicaid, 50% are in MCOs, 16%, in primary care case management programs; and 34%, in traditional fee-for-service programs.

Moreover, according to the survey, nearly two-thirds of those enrolled in Medicaid MCOs are in plans that primarily or exclusively serve Medicaid enrollees. Roughly half of MCO beneficiaries are covered by for-profit plans and the remainder, by non-profit plans.

“We see the prospect for an accelerated amount of activity in managed care in Medicaid because state budget and fiscal pressures are expected to continue,” says Vernon Smith, managing principal at Health Management Associates, which cooperated with Kaiser in preparing the survey. “State Medicaid programs are looking more to including populations that are more vulnerable into managed care,” and the prospect of a marked increase in the number of individuals on Medicaid under health reform looms large.

KMCU Executive Director Diane Rowland says that increasingly, states are incorporating quality metrics in their managed care programs to improve outcomes, measure performance, and reduce costs, with the term “care management” replacing the words “managed care.”

In other survey findings, a majority of states report that, for at least one Medicaid managed care program and/or geographic area, they now require enrollment in managed care for such populations as seniors. Half of states report some enrollment of those who are dually eligible for Medicaid and Medicare in managed care.


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