State Innovations in Child Welfare Financing. Managed Care Organization Model

04/01/2002

The managed care organization model involves the public agency’s contracting with a private organization that incorporates managed care principles into its subcontracts with service providers. Generally the private organization does not itself provide direct services. For example, every service area in Massachusetts is covered by a community-based child welfare agency that receives a set amount of money each year to provide functions such as gatekeeping, utilization review, creating and maintaining provider networks, monitoring quality of services, and accessing third-party reimbursement. The lead agencies generally subcontract for services, although they are allowed to provide up to 20 percent of the services delivered. In Missouri’s model, a private for-profit organization, which was created for the purpose, manages a network of providers and monitors quality and utilization of services.

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