Insuring the Poor Through Section 1115 Medicaid Waivers

Holahan, John; Coughlin, Teresa A.; Ku, Leighton; Lipson, Debra; Rajan, Shruti

doi:10.1377/hlthaff.14.1.199

Cited by 44 publications

(22 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…During this second phase of Medicaid managed care implementation, states most often relied on contracts with health maintenance organizations (HMOs) that were paid a capitated rate for providing a contractually specified set of services. Several states had expectations of savings that were so large that they simultaneously proposed using these savings to expand eligibility for Medicaid (Holahan et al 1995). In the rush to spend these expected savings, most states overlooked the fact that Medicaid fee-for-service rates already were well below those of private payers (Norton 1995) and that the potential for Medicaid plans to generate savings through provider discounts was much more limited than in the private sector.…”

mentioning

confidence: 99%

Has Medicaid Managed Care Affected Beneficiary Access and Use?

Zuckerman

Brennan²,

Yemane³

2002

INQUIRY

View full text Add to dashboard Cite

mentioning

confidence: 99%

Has Medicaid Managed Care Affected Beneficiary Access and Use?

Zuckerman

Brennan²,

Yemane³

2002

INQUIRY

View full text Add to dashboard Cite

“…5 Our focus on operations and effects in states leads us to expand on John Holahan's three-part framework to consider diverse aspects of eligibility and enrollment, managed care plan and provider participation, and state oversight. 6 Our focus is on access to care more than on financing, and we examine how the movement to managed care affects lowincome persons and the safety net.…”

Section: Study Methodsmentioning

confidence: 99%

Marketwatch: Medicaid Managed Care: Lessons From Five States

1996

View full text Add to dashboard Cite

With Medicaid managed care enrollment accelerating, policymakers must quickly understand the lessons from the states so that the transition to managed care strengthens access and care systems and avoids problems. Our study of five recent state experiences shows that state objectives must be realistic and well planned. The experience of states with long histories of managed care underscores the conclusion that managed care is not a magic bullet for solving all access and cost concerns and that no amount of managed care can substitute for adequately financed programs that are well understood by beneficiaries, providers, and health plans alike. The results highlight ten lessons from the states.

show abstract

“…Oregon, closely followed by Tennessee, led this parade, and soon after came Hawaii and Rhode Island. 11 These states committed to a course of converting the acute care part of their Medicaid programs into a prepaid health plan strategy. Even if managed care arrangements did not produce major savings-as some clearly realized they could not-they did provide a foundation for enrolling additional populations and guaranteeing them a medical home.…”

Section: The Managed Care Rising Tidementioning

confidence: 99%

Medicaid And Managed Care: A Lasting Relationship?

Hurley¹,

Somers²

2003

Health Affairs

View full text Add to dashboard Cite

ABSTRACT:The Medicaid program made a major commitment to managed care during the past decade. Following turbulent early years, the marriage matured and stabilized because managed care models responded well to a number of the states' goals and Medicaid purchasers were willing to make key trade-offs on behalf of their beneficiaries that conformed to the designs of managed care products. The relative tranquility in Medicaid managed care contrasts sharply with turmoil in both the commercial and Medicare sectors. But continuing changes in the managed care marketplace and financial distress in state budgets present new challenges to the strength and durability of this relationship. T h e r e w e r e n o g o o d o l d days in Medicaid.This assertion is key to understanding why state Medicaid agencies have so ardently embraced managed care models to try to improve the troubled federal-state partnership program for low-income and disabled persons. Wistfulness about pre-managed care days may prevail among privately insured patients and their physicians, but nostalgia has little place in Medicaid. From the program's beginnings in the mid-1960s, Medicaid policymakers struggled with adequate financing and coverage, sufficient provider participation, and appropriate access and service use for covered beneficiaries.1 By 1980 Medicaid's problems had snowballed and created huge challenges for federal and state officials to provide necessary services to nearly twenty million beneficiaries. These challenges set in motion a search for new methods and models for financing and delivery of care. Managed care, with its focus on cost-conscious consumption and provision of services, seemed to make for an especially good match for Medicaid.By 2002 more than 58 percent of Medicaid's beneficiaries were enrolled in managed care arrangements, with approximately 40 percent, or more than fifteen million, enrolled in health maintenance organizations (HMOs) and other prepaid health plans.2 While managed care in Medicaid encountered considerable turbulence in its early years, its relative tranquility in recent years compares favorably with commercial and Medicare managed care, which have been buffeted by con-M a n a g e d C a r e H E A LT H A F F A I R S~Vo l u m e 2 2 , N u m b e r 1 7 7

show abstract

Insuring the Poor Through Section 1115 Medicaid Waivers

Cited by 44 publications

References 0 publications

Has Medicaid Managed Care Affected Beneficiary Access and Use?

Has Medicaid Managed Care Affected Beneficiary Access and Use?

Marketwatch: Medicaid Managed Care: Lessons From Five States

Medicaid And Managed Care: A Lasting Relationship?

Contact Info

Product

Resources

About