Medicaid Managed Care: Summary Reports
This paper examines the implementation of full-risk Medicaid Managed Care for the TANF population in ten states. It assesses state success at achieving three interconnected management objectives: (1) Developing the organizational capacity, either in-house or through contractors, to manage managed care effectively; (2) Becoming a “prudent purchaser” of managed care by developing contractual standards for quality of care and other measures, collecting data to measure compliance with these standards, and rewarding or sanctioning health plans based on their performance; and (3) Developing political constituencies among governors, legislators, providers, plans, and advocacy groups to support and advance their programmatic objectives. The findings are mixed.
James W. Fossett, Center for Health Care Strategies, 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
This report assessed the implementation of Medicaid managed care in five states, focusing on mechanisms states put in place to oversee the operations of managed care organizations enrolling Medicaid recipients and states’ success at holding these organizations accountable for the care they provide clients. It examines those portions of state managed care programs that enroll the women and children in the AFDC or TANF populations rather than the elderly and disabled populations, who are eligible for Medicaid through their receipt of Supplemental Security Income (SSI).
James W. Fossett and Associates: Malcolm Goggin, John S. Hall, Jocelyn Johnson, Christopher Plein, Richard Roper, Carol Weissert, 1999.