Mandated Managed Care for Medicaid

Article excerpt

How are Medicaid beneficiaries and the hospitals who serve them faring now that many states have established mandated managed care? What is the impact of mandated managed care on Medicaid beneficiaries with chronic illnesses? Will Medicaid recipients be disadvantaged by having physicians and health maintenance organizations (HMOs) assigned to them, rather than choosing their own?

These are questions John Kuder, associate professor of policy analysis and management and director of Cornell's Sloan Program in Health Administration, is addressing. His research has long been concerned with the organization, financing, and economics of health services, how public policy shapes them, and how those changes influence decisions by people and health service providers. Lately, he has been studying the effects of mandated managed care for Medicaid, especially in large cities.

"Basically, 47 states are going to some form of managed care for the Medicaid population," Kuder says. "Every Medicaid beneficiary must be in managed care."

He sees two advantages of mandated managed care: the system saves money for a state government, and people who wouldn't choose a physician or HMO if left to their own devices will have them assigned, ensuring that they'll have a place to go for their health care needs. That was the object of creating the system. Its other effects remain to be seen and, once studied, used to understand how else the Medicaid system could be adjusted to benefit the people involved.

"We're looking at two substantial issues," Kuder notes. "One, what is happening to the providers of safety-net services? Is the safety net getting stronger or weaker as a result of mandated managed care? Two, since all Medicaid beneficiaries have to be under a managed care organization, what happens to those who don't sign up and are assigned an HMO and physician by the state? Does this affect their access to care? Will switching plans and providers result in inconsistent care? …