This chapter begins with a brief overview of developments nationally, then focuses on approaches being used in case study sites. States are increasingly relying on managed care approaches to finance and deliver health care and behavioral health services to people enrolled in Medicaid. Under a managed care approach, states often provide capitated, per-member per-month financing to Managed Care Organizations (MCOs) that in turn contract with health care providers under arrangements intended to reduce costs and increase care quality and coordination.
As states enroll growing numbers of people in Medicaid managed care plans, including PSH tenants and people who are experiencing chronic homelessness, it will be essential for many of the organizations that provide Medicaid-covered health services to indigent and homeless people to become part of the health plans' provider networks. If they do not, they will not be able to obtain Medicaid reimbursement for delivering covered services to plan members. Service providers working to help facilitate access to health care and coordinate care for people who are chronically homeless and PSH tenants will need to understand the impact of managed care enrollment on the services available to their clients and patients.