Medicaid managed care: the next generation?

The author provides an overview of the motivation leading nearly every state to develop managed health care arrangements under the state and federally funded Medicaid program for the poor. With managed care already a reform movement in state Medicaid efforts, further expansions of similar types of organized systems of care are anticipated in the future U.S. health care system. The author explores the acceleration of state investment in managed care planning and operations in terms of what is happening and whether expectations are being met. Specific plan features representing two very different managed care models within the evolution of how these plans have developed over time--Arizona's statewide prepaid plan begun in 1982 and New York's recently expanded statewide program designed to enroll 50% of those eligible within five years--are described. The author raises questions about these programs based on recent literature and discussions with key informants. Are sufficient providers out there and are there optimum ways to organize delivery networks? What additional safeguards may be required to protect consumers under managed care arrangements, and what are the effects of such programs on access to services and quality of care? What obstacles do health plans that traditionally serve mainly poor women and children have to overcome when serving people with disabilities or those with chronic health conditions? The author considers other barriers faced by states, providers, and policymakers in meeting the high expectations for the current generation of state-supported managed care plans. These questions and issues will remain important for some time as the states' efforts to promote managed care continue their anticipated expansion under health care reform.