Abstract
This article provides new empirical data about the viability and the care management activities of Medicaid managed-care plans sponsored by provider organizations that serve Medicaid and other low-income populations. Using survey and case study methods we studied these “safety-net” health plans in 1998 and 2000. Although the number of safety-net plans declined over this period, the surviving plans were larger and enjoying greater financial success than the plans we surveyed in 1998. We also found that, based on a partnership with providers, safety-net plans are moving toward more sophisticated efforts to manage the care of their enrollees. Our study suggests that, with supportive state policies, safety-net plans are capable of remaining viable. Contracting with safety-net plans may not be an efficient mechanism for enabling Medicaid recipients to “enter the mainstream of American health care,” but it may provide states with an effective way to manage and coordinate the care of Medicaid recipients, while helping to maintain the health care safety-net for the uninsured.
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References
Congressional Research Service. Medicaid Source Book: Background Data and Analysis: a Report. Prepared by the Congressional Research Service for the use of the Subcommittee on Health and the Environment of the Committee on Energy and Commerce US House of Representatives, Washington DC: US Government Printing Office; 1993: Appendix H, 1041.
Stevens R, Stevens R. Welfare Medicine in America: a Case Study of Medicaid. New York: Free Press; 1974.
Holahan J, Zuckerman S, Evans A, Rangarajan S. Medicaid managed care in 13 states. Health Aff. 199817(3):43–63.
Dallek G. A consumer advocate on Medicaid managed care. Health Aff., 1996;15(3): 172–173.
Oliver TR. Reflections on the “revolution” in Maryland: the collision of economics and politics in Medicaid managed care. Report to the Milbank Memorial Fund, New York, New York; October 1996.
Grogan CM, Gusmano MK. Deliberative democracy and the poor. Book manuscript in preparation.
Somers SA, Hurley R, Oehlmann ML. Staying the course: pursuing value in the Medicaid managed care era and beyond. J. Urban Health. 2000;77:519–536.
McCue MJ, Hurley RE, Draper DA, Jurgensen M, Reversal of fortune: commercial HMOs in the Medicaid market. Health Aff. 1999;18(1):223–230.
Felt-Lisk S, The Characteristics and Roles of Medicaid-Dominated Managed Care Plans. Princeton, NJ: Mathematica Policy Research; February 2000:iii.
Brown R, Wooldridge, J, Hoag S, Moreno L, Reforming Medicaid: the Experiences of Five Pioneering States with Mandatory Managed Care and Eligibility Expansions. Report submitted to the Office of Strategic Planning, HCFA Princeton, NJ: Mathematica Policy Research; 2001.
Gray BH, Rowe C. Safety-net health plans: a status report. Health Aff. 2000;19(1):185–193.
Ku L, Hoag S. Medicaid managed care and the marketplace. Inquiry. 1998;35:332–345.
Sparer MS, Brown LD. Uneasy alliances: managed care plans formed by safety-net providers. Health Aff. 2000;19(4):23–35.
Felt-Lisk S. Monitoring quality in Medicaid managed care: accomplishments and challenges at the year 2000. J Urban Health. 2000;77:536–559.
Roohan PJ, Conroy MB, Anarella JP, Butch JM, Gesten FC. Commercial managed care plans leaving the Medicaid managed care program in New York State: impact on quality and access. J Urban Health. 2000;77:560–572.
New York State Department of Health. InterStudy Competitive Edge HMO Directory. Minneapolis, MN: InterStudy Publishing; 1998.
Patton CV. Grady HMO was successful, considering the constraints. Atlanta Journal Constitution. October 20, 1999:A23.
Pendered D. Grady to shut down HMO program prompted by state action; trustees vote to end both Medicaid and managed care plans. Atlanta Journal Constitution. September 28, 1999:E1.
Shaw M. St. Mary's sells its Medicaid care unit; the Chicago buyer wants to recruit doctors and add patients. St. Louis Post-Dispatch. August 1, 2000:C6.
Health Care Financing Administration. Medicaid managed care enrollment report (1996–2000). Available at: www.hcfa.gov/medicaid. Date accessed: December 6, 2001.
Sparer MS, Brown LD, Gusmano MK, Rowe, C, Gray BH. Promising practices: managing the care of the Medicaid client. Health Aff. 2002;21:5.
Fossett JW, Goggin M, Hall JS, et al. Managing Medicaid managed care: are states becoming prudent purchasers? Health Aff. 2000;19(4):36–49.
Waxman J. Medicaid Managed Care Regulations Issued: What Do They Do? Will They Be Implemented? Families USA Field Report; March 2001.
Hurley R, McCue M. Partnership Pays; Making Medicaid Managed Care Work in a Turbulent Environment Princeton, NJ: Center for Health Care Strategies; May 2000.
Ginsburg PB. The changing face of managed care: results from the community tracking study site visits, 2000–2001. Report presented at: the Eighth Princeton Conference, Princeton, NJ, May 18, 2001.
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Gusmano, M.K., Sparer, M.S., Brown, L.D. et al. The evolving role and care management approaches of safety-net medicaid managed care plans. J Urban Health 79, 600–616 (2002). https://doi.org/10.1093/jurban/79.4.600
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DOI: https://doi.org/10.1093/jurban/79.4.600