Medicaid: States Turn to Managed Care to Improve Access and Control Costs

GAO discussed the role of managed care in state Medicaid programs. GAO noted that: (1) although prepaid health care plans are still the most common, states are finding it easier to recruit providers to primary care case management programs; (2) states choosing managed care programs face issues that include planning implementation, moving to mandatory enrollment, and establishing beneficiary education programs; (3) Medicaid managed care programs have had mixed results in improving access to care, ensuring the quality of services, and saving money; (4) states choosing managed care are under pressure to monitor access and quality of services provided to Medicaid beneficiaries to ensure that providers' medical decisions are not compromised by financial incentives; and (5) states are working to improve their quality assurance and financial monitoring systems, and are looking to the Health Care Financing Administration for help in developing better ways to measure quality and provider solvency.