Embry Howell, Ashley Palmer, and Fiona Adams
This review of Medicaid and CHIP risk-based managed care over 2001-2010 shows that well-established programs exist in 19 of the 20 study states. While there is substantial variation across states, all the study states have developed ways to regularly select plans, define network requirements, and monitor access and quality. There is substantial stability in the number and types of plans. HEDIS and CAHPS data suggest that preventive care use has improved and that beneficiaries are generally satisfied with their health plans. Thus, the risk-based managed care programs provide a structure to absorb the newly covered adults under the Affordable Care Act, and provide a learning laboratory and important lessons for other states. [101 PDF pages]
The authors acknowledge the advice and assistance of their project officer, Rose Chu, at the Office of the Assistant Secretary for Planning and Evaluation (ASPE)/DHHS, and of other staff at ASPE and the Centers for Medicare and Medicaid Services who provided advice and comments on the report. We also thank all of the respondents who provided time and data throughout the project; they provided almost all the information in the report. Finally, we thank our colleagues at the Urban Institute. Teresa Coughlin and Brigette Courtot conducted interviews, analyzed information, and reviewed the report. John Holahan provided guidance throughout. Vicki Chen, Matthew Carey, and Maya Joyce provided research assistance, and Eva Hruba prepared the document.