TennCare represents one of the most ambitious state-level efforts to restructure Medicaid and expand insurance coverage to the uninsured. The case study shows that the rapid change caused considerable confusion for patients, providers, and health plans. The TennCare experience provides early insights into the issues that states will face as they move to enroll more of their low-income populations into managed care arrangements.
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The issue paper discusses the enrollment process from the perspectives of both beneficiaries and participating plans in nine states with mandatory Medicaid managed care programs: California, Connecticut, Florida, Maryland, Michigan, Missouri, New Mexico, Oklahoma, and Oregon.Issue Paper
This report reviews and synthesizes the literature from the past 20 years evaluating managed care's impact on access, quality, beneficiary's health status, and the cost of care for the Medicaid population.Report:
A Review of the Waiver Applications, Letters of Approval and Special Terms and ConditionsThis background paper provides a summary of the key features of the Medicaid 1115 waivers that have been approved, proposed, implemented and conditionally rejected. This July version updates Medicaid 1115 Demonstration Waivers: Approved and Proposed Activities as…
The describes the new legal and policy framework within which the shift of state Medicaid programs from fee-for-serviceto managed care will take place over the next few years.Report Report
This fact sheet provides an overview of the Medicaid program’s increasing reliance on managed care to deliver services.Fact Sheet
A new background report sums up how multiple trends have led to a situation where safety net hospitals are feeling more financial pressure and are challenged to subsidize the unprofitable care of theuninsured.Background Paper For a more extensive discussion read our larger report from the same study.
Medicaid Managed Care for Dual Eligibles: Case Studies of Programs in Georgia, Minnesota, and Pennsylvania
This report, a companion piece to publication #2246, presents detailed case studies of the managed care programs that enroll dual eligibles in three states: Georgia, Minnesota and Pennsylvania.Report
Protection For Consumers In Managed Care Plans: A Comparison Of Medicare, Medicaid and the Private Insurance Market
This policy paper describes key requirements of consumer protection regulation under Medicare, Medicaid and federal and state laws as they apply to private health insurance. These include choice and availability of plans, disclosure of information, marketing, access, quality, and the grievance and appeals process. The discussion highlights differences and similarities…
An updated study follows trends in commercial health plan participation in Medicaid managed care and includes new analyses on the performance of Medicaid-dominated and commercial plans on measures of effective care and access to care, and on the extent to which plans restrict their Medicaid service areas.