Online Program

Does managed care under Medicaid save money and expand access?

Monday, November 4, 2013 : 12:30 p.m. - 12:50 p.m.

Johnathon Ross, MD, MPH, Outpatient Adult Medicine, Mercy St. Vincent Medical Center, Toledo, OH
There is a paucity of high quality research to demonstrate that managed care Medicaid saves money or improves the care of patients vs. the traditional fee for service Medicaid program. Despite this many states are turning to mandatory enrollment of all Medicaid patients in managed care including the aged poor and disabled. This paper will review the evidence to date on cost and quality and discuss the problems related to the evaluation of the effects of managed care on Medicaid. The Kaiser Family Foundation has assembled an extensive data base about costs and coverage at the state level. Statistical analysis of this data again reveals no clear and convincing evidence that managed care under Medicaid saves money or improves outcomes. The implications of these findings for cost control under the Affordable Care Act are also discussed.

Learning Areas:

Provision of health care to the public
Public health or related public policy

Learning Objectives:
Compare those states where Medicaid is mostly or completely administered under managed care entities to those with less or no managed care in terms of coverage and cost control. The advantages and disadvantages of these programs for the Medicaid population will be discussed.

Keyword(s): Access to Care, Cost Issues

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have taught and published on health reform for over 30 years. I was also the medical director for a Medicaid HMO in the 1990's.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.