Has the Shift to Managed Care Reduced Medicaid Expenditures? Evidence from State and Local-Level Mandates

@article{Duggan2011HasTS,
  title={Has the Shift to Managed Care Reduced Medicaid Expenditures? Evidence from State and Local-Level Mandates},
  author={Mark G. Duggan and Mark G. Duggan and Tamara Beth Hayford},
  journal={ERN: National},
  year={2011}
}
From 1991 to 2009, the fraction of Medicaid recipients enrolled in HMOs and other forms of Medicaid managed care (MMC) increased from 11 percent to 71 percent. This increase was largely driven by state and local mandates that required most Medicaid recipients to enroll in an MMC plan. Theoretically, it is ambiguous whether the shift from fee-for-service into managed care would lead to an increase or a reduction in Medicaid spending. This paper investigates this effect using a data set on state… 
View on SSRN
repository.upenn.edu
94 Citations
Highly Influential Citations
5
Background Citations
45
Methods Citations
6
Results Citations
3

94 Citations

The Fiscal Cost of Providing Medicaid to Disabled Beneficiaries through Private Managed Care Plans

It is found that a transition to managed care eventually increases Medicaid’s fiscal spending, and it is suggested that spending tends to increase more in states that have lower pre-mandate payment rates to providers.

Effect of privatized managed care on public insurance spending and generosity: Evidence from Medicaid

Which areas of spending are differentially affected by managed care enrollment and whether savings from managed care affect Medicaid design, specifically coverage generosity are identified, show reductions in Medicaid spending larger than previously found in cross-state studies.

Health Insurance Generosity and Conditional Coverage: Evidence from Medicaid and Managed Care in Kentucky

The findings suggest that the introduction of MMC increases the likelihood of being uninsured and decreases formal Medicaid participation, consistent with an increase in “conditional coverage” – waiting until medical care is needed to sign up or re-enroll in Medicaid.

Heterogeneity in the Impact of Privatizing Social Health Insurance: Evidence from California's Medicaid Program

The results suggest the adverse impact of MMC varies by the health of enrollees, which should inform the optimal outsourcing decision for governments.

Do the Poor Benefit from More Generous Medicaid Policies?

It is found that payment increases generate an increase in supply of care to Medicaid patients but a more than offsetting decrease in supply to the uninsured, which suggests payment increases should be coupled with eligibility expansions in order to improve access to care among the poor.

Medicaid managed care and preventable emergency department visits in the United States

It is found that the type of Medicaid held by a recipient, i.e., whether an HMO or FFS coverage, was unrelated to the probability that an ED visit was potentially preventable, and this finding emerged both among dual eligibles and among non-duals.

Do the Poor Benefit From More Generous Medicaid Physician Payments?⇤

It is found that payment increases generate an increase in supply of care to Medicaid patients but a more than offsetting decrease to the uninsured, and that when Medicaid eligibility is high, physicians are less likely to substitute between caring for Medicaid patients and treating the uninsured.

Do Insurers Risk-Select Against Each Other? Evidence from Medicaid and Implications for Health Reform

A simple model of risk-selection in capitated private health plans incentivizes insurers to retain low-cost clients and thus improve their care relative to high- cost clients, who they prefer would switch to a competitor.

Utilization of and Relationships With Primary Care Providers During the Transition to Medicaid Managed Care

Regression analyses showed that enrollment in MMC was significantly related to each of the three outcomes; MMC enrollees were more likely than the FFS group to see a PCP during the 1-year post-period and have high levels of continuity of care with a single PCP.

How does managed care manage care? Evidence from public insurance

Two dissertation chapters provide new perspective on how differences within public programs and between public and private programs, impact consumers.
...

References

SHOWING 1-10 OF 45 REFERENCES

Does Contracting Out Increase the Efficiency of Government Programs? Evidence from Medicaid Hmos

State governments contract with health maintenance organizations (HMOs) to coordinate medical care for nearly 20 million Medicaid recipients. Identifying the causal effect of HMO enrollment on…

National Estimates of the Effects of Mandatory Medicaid Managed Care Programs on Health Care Access and Use, 1997–1999

The effects of Medicaid managed care vary with the type of program, and policy makers should not expect programs that rely on PCCMs to have the same effects as those that incorporate mandatory HMO enrollment.

Effects of Medicaid managed care programs on health services access and use.

This study uses pooled individual-level data from up to five years of the NHIS and information on Medicaid managed care characteristics at the county level from the 1998 MMC survey, which finds virtually no effects of mandatory PCCM programs.

Using HMOs to serve the Medicaid population: what are the effects on utilization and does the type of HMO matter?

There is some evidence that utilization and access are related to the market penetration rates of commercial and Medicaid-dominant HMOs, but the pattern of results does not appear to be consistent with welfare improvements.

The Impact of Medicaid Managed Care on Primary Care Physician Participation in Medicaid

This study failed to find that increases in Medicaid managed care lead to increased primary care physician participation in Medicaid during the period 1996–2001.

Selection, Marketing, and Medicaid Managed Care

It is found that managed care enrollees differed from those who stayed in traditional Medicaid on both observable and unobservable characteristics, and that enrollees who learned about plans from plan representatives were healthier than those who learnedAbout plans from city income support staff.

Does Managed Care Improve Access to Care for Medicaid Beneficiaries with Disabilities? A National Study

There is some evidence of improved access to care under MMC; however, the gains appear to be largely limited to beneficiaries in urban areas with fully capitated managed care.

Medicaid managed care and health care for children.

Increases in Medicaid health maintenance organization (HMO) enrollment are associated with less emergency room use, more outpatient visits, fewer hospitalizations, higher rates of reporting having put off care, and lower satisfaction with the most recent visit.

Medicaid Managed Care: Effects on Children&Apos;S Medicaid Coverage and Utilization

Medicaid and Managed Care: Key Data, Trends, and Issues-Policy Brief

  • Medicine, Political Science
  • 2010
The fundamental idea is to improve access to care and coordination of care by assuring that enrollees have a “medical home” with a primary care provider, and to rely more heavily on preventive and primary care.