The 130th Annual Meeting of APHA

Abstract #48354

Pam C. Silberman, JD, DrPH, Rebecca Slifkin, PhD, and Stephanie Poley, BA. Sheps Center for Health Services Research, UNC-Chapel Hill, 725 Airport Road, CB# 7590, Chapel Hill, NC 27599-7590, 919-966-2670, silber@mail.schsr.unc.edu

This study has two components: an update to a 1997 study examining implementation of rural Medicaid managed care program, and a three-state case study of innovative Primary Care Case Management programs. Between October 2000 and March 2001, we conducted semi-structured telephone interviews with knowledgeable Medicaid officials in the 48 states with Medicaid managed care programs. Most states operate Medicaid managed care programs, but the type of program varies across urban and rural areas. Over the last four years, the number of rural counties covered by Medicaid managed care has grown, although Primary Care Case Management (PCCM) remains the predominant rural Medicaid managed care program. By 2001, more than half of rural counties and three-quarters of urban counties operated some type of Medicaid managed care system. Provisions of the Balanced Budget Act that were enacted to help states implement capitated Medicaid managed care programs in rural areas have not eased rural implementation problems. Instead, states have developed special contracting strategies or financial incentives to encourage managed care organizations to cover rural areas. In some states, health plan withdrawals have led the Medicaid agencies to examine alternative approaches to cover their Medicaid population. Several states are developing "enhanced" primary care case management programs, combining traditional PCCM with disease management or case managers. This study highlights three states that have tried to implement enhanced primary care case management in rural communities: North Carolina, Florida and Oklahoma.

Learning Objectives: At the end of this session, the participants will be able to

• Identify trends in rural Medicaid managed care programs
• Describe innovative Medicaid managed care case management and disease management programs
• Assess the feasibility of developing case management and disease management programs for the rural Medicaid populations in the participant's state.

Keywords: Medicaid Managed Care, Disease Management

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.