Implementation of Medicaid Managed Care: Lessons Learned

Background:  In 2011, one Midwestern state instituted a pilot program moving people with disabilities from fee-for-service to mandatory Medicaid Managed Care (MMC). In 2014, it expanded to new areas. This presentation will review areas of concern from the pilot and if/how MMC expansion addressed those concerns.

Methods:  The study uses surveys of MMC enrollees during the transition years (n=411 in 2011­-12 [pilot) and 398 in 2014-15 [new regions]). We also review quality performance measures and readiness reviews for the Managed Care Organizations (MCOS) in each region.

Results:  A major issue identified during the pilot was continuity of care; 66% of survey respondents had to see at least one new doctor, but in the new MMC regions, only 40% did. Continuity of care is significantly related to health services appraisal and satisfaction with the program. Network development and quality performance are other challenges early in the transition; the MCOs in the new region had many of the same problems as the initial pilot, although the two MCOs that were also involved in the pilot did not have the same degree of difficulty.

Conclusion:  The transition to MMC is often filled with confusion, new policies to learn, and other challenges for new enrollees and for the MCOs. A pilot offers the opportunity to learn from the past so that MMC can be more effectively implemented in new regions. Our review shows that the state and MCOs did learn from the past in some regard, but there is still room for improvement.