The Quality of Medicaid Managed Health Care Plans

In the U.S., traditional fee-for-service Medicaid has largely been replaced by a managed care system.

Medicaid managed care is a system under which Medicaid beneficiaries can receive health care services through a managed care organization, which focuses on primary and preventative care. As of 2009, 33 million people were enrolled in Medicaid managed care plans, more than half of the total Medicaid population.

History

Faced with rising Medicaid costs in the late 1990s, many U.S. states began to move toward a managed care system for delivering Medicaid services. Traditional fee-for-service Medicaid was largely replaced by a managed care system, in which payments are made on a per-person and per-month basis, and where the emphasis is on a coordinated system of care.

Problems

Patients covered by Medicaid managed care plans were likely to receive substandard care compared to commercial health plans, according to an analysis of data by Bruce E. Landon, an associate professor of health care policy at Harvard Medical School. As an example, Medicaid patients received recommended breast cancer screening 52.6 percent of the time, compared to 75.1 percent for patients covered by commercial HMOs.

Costs

The number of Medicaid beneficiaries covered under managed care grew substantially, and total Medicaid expenditures for managed care rose from $27 billion in 2000 to $61 billion in 2007, according to the Kaiser Family Foundation.

References

• Kaiser Commission on Medicaid and the Uninsured: Medicaid and Managed Care: Key Data, Trends and Issues; February 2010.
• MedPage Today: Quality Found Lacking in Medicaid Managed Care; Peggy Peck; October 2007.
• U.S. Congressional Research Service: Medicaid Managed Care: An Overview and Key Issues for Congress; Elicia J. Hertz; October 2006.