Medicaid Managed Care Program

Helping states and managed care health plans improve the care provided to beneficiaries of Medicaid and the State Children's Health Insurance Program

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.

“Overall, the Medicaid Managed Care Program reached large sectors of its intended audiences between 2000 and 2003 with products that were well-regarded, and the program’s support led to concrete changes in the way some states and health plans delivered Medicaid managed care.”—Evaluators at Mathematica Policy Research

Key Results

  • Mathematica Policy Research evaluated the Medicaid Managed Care Program’s work between 2000 and 2003. Key findings include:

    • Overall, the Medicaid Managed Care Program reached large sectors of its intended audiences between 2000 and 2003 with well-regarded products, and the program’s support led to concrete changes in the way some states and health plans delivered Medicaid managed care.
    • Half of the 43 Medicaid directors made concrete improvements in their Medicaid managed care programs as a result of participating in the Medicaid Managed Care Program.
    • The health plans made changes in the way they delivered care based on their participation in the Medicaid Managed Care Program.
    • The Medicaid Managed Care Program’s integration of technical assistance and other support to state Medicaid agencies and Medicaid managed care plans appears to have led many staff members of these organizations to change their thinking about how they purchased and provided Medicaid managed care.
  • Key results of the entire program include:

    • The Medicaid Managed Care Program helped transform Medicaid to a quality health insurance program by helping state Medicaid agencies become better purchasers of health care and managed care plans to deliver better care to Medicaid beneficiaries.
    • Through the Medicaid Managed Care Program, the Center for Health Care Strategies (CHCS) has become the go-to resource for guidance to states, managed care plans, and other stakeholders on organizing, financing, and delivering high-quality, publicly financed care.
    • CHCS has secured funding to continue its work to improve Medicaid from RWJF, other foundations, and the federal government. Much of this work is providing technical assistance to the states on foundation and federal programs.

“Overall, the Medicaid Managed Care Program reached large sectors of its intended audiences between 2000 and 2003 with products that were well-regarded, and the program’s support led to concrete changes in the way some states and health plans delivered Medicaid managed care.”—Evaluators at Mathematica Policy Research

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