Medicaid and CHIP Risk-Based Managed Care in 20 States. Experiences Over the Past Decade and Lessons for the Future.. Provider Networks


Once states have selected plans to participate in their Medicaid and CHIP risk-based managed care programs, they then delegate (as specified in contractual requirements) the responsibility for selecting a network of service providers. This provider network defines which providers a Medicaid/CHIP enrollee can access: Primary Care Providers (their first point of contact), specialists, hospitals, or other service providers. Thus the size and composition of the provider networks (by provider type and geographical location) are largely responsible for the degree of access to care that beneficiaries have under risk-based managed care.

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