Medicaid Managed Care: Case Studies
This report, which is based on data collected in the fall of 2002, looks at the Commonwealth of Pennsylvania's Medicaid management organization and assesses whether this state has been able to meet the management standards embodied in the notion of “prudent purchasing.”
Jocelyn M. Johnston, 2003
This report analyzes what ten state Medicaid managed-care programs around the country were doing in 1999 with respect to acquiring, analyzing, and using data. The reports of twelve Rockefeller Institute field researchers suggest that some states are better equipped than others to implement plans to collect, analyze, and use data to manage their Medicaid managed-care programs. Yet while many states will not be able to achieve the “gold standard” set by Arizona's Health Care Cost Containment System, every state can adopt at least some measures to move in that direction. This report offers practical steps.
Malcolm L. Goggin, 2002
This report shares findings from a ten-state study of Medicaid managed-care, with a focus on state management systems and the organizations responsible for administering Medicaid. The transition from fee-to-service Medicaid to managed care poses major new challenges to state administrators. This research, conducted in the summer of 1999, provides insights into how and why states have shaped their current management systems to adjust to this transition.
Jocelyn M. Johnston, 2002
This report seeks to help shed light on the role of political actors in Medicaid managed-care policymaking by analyzing political leadership and lobbying in ten states.
Carol S. Weissert, 2002
This paper, published in Health Affairs, examines the extent to which five states are becoming “prudent purchasers” in their oversight of Medicaid managed care. Becoming a prudent purchaser appears to be a complex task for states that may prove difficult to achieve.
James W. Fossett, Malcolm Goggin, John S. Hall, Jocelyn Johnston, L. Christopher Plein, Richard Roper, and Carol Weissert, Health Affairs, Vol. 19, No. 4, 2000
The implementation of Medicaid managed care reforms in the state of Kansas has followed a rocky road shaped by a combination of political and policy imperatives and market conditions that often conflict with those imperatives. This report examines these conditions and its effects.
Jocelyn M. Johnson, 2000
Following Governor Engler's order to “fire, ready, aim,” Michigan's ambitious managed care program was initiated and enforced statewide for over 700,000 Medicaid clients in the span of less than two years. Why these changes occurred and how they were implemented constitute the core of this analysis.
Carol S. Weissert and Malcolm L. Goggin, 2000
Getting More Than What's Bargained For: The Hidden Administrative Costs of West Virginia Mountain Health Trust Program[PDF]
The story of Medicaid managed care in West Virginia is one in which political expediency and the allure of a simple fix for the system clouded more reasoned assessments of the capacity of the state to pursue a new program regime. This paper examines this experience by first discussing the underlying political pressures for change in the face of program costs and budget constraints. Attention then turns to the popularity of HMO-based Medicaid managed care and how the state's Mountain Health Trust Program was designed along these lines. The paper then analyzes the administrative burdens of establishing the program and continuing costs and issues associated with maintaining the program.
L. Christopher Plein, 2000.
As a part of the larger Rockefeller Institute study of state capacity to manage devolution, we conducted numerous interviews with experts close to the AHCCCS experiment over its development, and examined existing program history, information, and evaluations. Our purpose in this research was to look closely at the ability of states to formulate and implement coherent, plausible, and broadly responsive Medicaid policy as a key ingredient of governing capacity.
John Stuart Hall and Melinda Snook Hollinshead, 2000