Performance Improvement 2001. New Rules, New Roles: How Title V/MCH and Ryan White Programs and Providers are Adapting to Medicaid Managed Care


This study examined how Medicaid managed care is affecting state agencies and local medical and social service providers funded under the Title V/MCH Services Block Grant program or the Ryan White CARE Act. Managed care has raised different issues for the two programs: for example, only the Title V/MCH program has had to address issues related to its public health role. Several themes repeatedly recurred during visits to Title V/MCH and Ryan White organizations, namely: Many Title V/MCH and Ryan White medical providers have been able to contract with managed care plans for at least some services; Whether providers receive any Medicaid reimbursement for case management depends largely on Medicaid program requirements; Providers contend that reimbursement rates are too low, regardless of whether they are reimbursed by managed care plans, the state Medicaid agency, or the Title V/MCH or Ryan White programs; Many social service providers lack the managed care expertise and staff resources to market their services to managed care plans; Providers that have managed care contracts are struggling with increased administrative demands; Program and provider staff believe that, in general, access to care and quality of care remain adequate, but fear that both may suffer if financial pressure continues to mount.

AGENCY SPONSOR: Health Resources and Services Administration

FEDERAL CONTACT: Alexander Ross, 301-443-1512

PIC ID: 6816

PERFORMER: Mathematica Policy Research, Inc., Washington, DC