“…Under PCCM, they may continue to limit Medicaid patients or stop accepting them altogether. Many early PCCM programs were implemented with compromises, including fee increases, the inclusion of outpatient departments and other established sites as primary care providers, and less than vigorous enforcement of gate-keeping requirements in order to avoid disrupting existing Medicaid delivery systems (Hohlen et al 1990;Hurley, Freund, and Paul 1993;Schoenman, Evans, and Schur 1997). States implementing PCCM have been urged to carefully recruit and make attempts to retain physicians, and to maintain or increase physician reimbursement rates in order to avoid the loss of participating physicians (Smith, Des Jardins, and Peterson 2000;Norton and Zuckerman 2000).…”