Emerging Practices in Medicaid Primary Care Case Management Programs. First Wave


The Omnibus Budget Reconciliation Act (OBRA) of 1981 allowed state Medicaid programs to implement both PCCM and risk-based managed care programs, pending HCFA(now known as CMS) waiver approval. HCFA(now known as CMS) approval required that the state satisfy two requirements.

  • The case management restrictions must not "substantially impair access" to primary care services of "adequate quality where medically necessary;" and
  • The case management restrictions must be "cost effective."3

Many states focused their first efforts in managed care on PCCM programs, with the goal of moving to risk-based contracting later.

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