Dates of Program: 1995–2012
Field of Work: Improving the quality of and access to health care through Medicaid
Half of the 43 Medicaid directors made some improvements in their Medicaid managed care programs as a result of participating in the Medicaid Managed Care Program.—Mathematica Policy Research Evaluation
Problem Synopsis: By 1995, most states were using managed care in their Medicaid programs to control health care costs, and hopefully, to improve access to care and the quality of that care. To use managed care effectively, state Medicaid agencies needed to become sophisticated group purchasers in a dynamic market and protect beneficiaries from managed care organizations that did not provide adequate services. Most managed care organizations lacked experience with the Medicaid population: mostly low-income people with unfamiliar health and social problems.
Synopsis of the Work: The Medicaid Managed Care Program helped states and health plans improve their use of managed care for Medicaid and State Children’s Health Insurance Program beneficiaries between 1995 and 2012. The goal was to improve access to and the quality of publicly financed managed care.
The program used a collaborative learning approach that focused on bringing together groups of states and groups of health plans to collaborate and then combining these and other groups in multi-stakeholder collaboratives. It also provided other technical assistance and training, made grants, and supported research and analysis and other projects.
To a lesser extent, the program supported some work to help consumers navigate and establish a formal role in Medicaid and similar managed care systems through grants to consumer and family-based organizations.