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Medicaid Managed Care's Effects on Costs, Access, and Quality: An Update

Authors
  • Franco Montoya, Daniela
  • Chehal, Puneet Kaur
  • Adams, E. Kathleen
Type
Published Article
Journal
Annual Review of Public Health
Publisher
Annual Reviews
Publication Date
Apr 01, 2020
Volume
41
Pages
537–549
Identifiers
DOI: 10.1146/annurev-publhealth-040119-094345
Source
Annual Reviews
Keywords
License
Green

Abstract

Medicaid is integral to public health because it insures one in five Americans and half of the nation's births. Nearly two-thirds of all Medicaid recipients are currently enrolled in a health maintenance organization (HMO). Proponents of HMOs argue that they can lower costs while maintaining access and quality. We critically reviewed 32 studies on Medicaid managed care (2011–2019). Authors reported state-specific cost savings and instances of increased access or quality with implementation or redesign of Medicaid managed-care programs. Studies on high-risk populations (e.g., disabled) found improvements in quality specific to a state or a high-risk population. A unique model of managed care (i.e., the Oregon Health Plan) was associated with reduced costs and improved access and quality, but results varied by comparison state. New trends in the literature focused on analysis of auto-assignment algorithms, provider networks, and plan quality. More analysis of costs jointly with access/quality is needed, as is research on managing long-term care among elderly and disabled Medicaid recipients.

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