States rely on HMOs for Medicaid care because they offer guaranteed access to comprehensive benefits at a predictable cost. This is true despite the private sector's movement away from HMOs, or at least the more restrictive variants. Plans that focus on Medicaid are becoming more central to...

Reviews projects in TN, HI, RI, OK, and MD, where there were large expansions of Medicaid managed care implemented through Section 1115 demonstration waivers. Notes that the projects were controversial and chaotic in the beginning but have matured with time and that Tennessee's expansion reduced...

Reviews the experiences of FQHCs in HI, RI, and TN before and after Medicaid managed care, noting that all survived despite challenges in adapting to managed care. Overall, financial performance was better than expected because coverage expanded to previously uninsured people, and FQHCs in two...

A synthesis of findings from all components of the evaluation concludes that each of the five states, by introducing managed care, have enhanced the potential for improving the quality of care delivered to Medicaid beneficiaries. In addition, the coverage expansions yielded much better...

This report, based in part on a survey of state Medicaid directors in 50 states, examines current and potential local government roles in Medicaid managed care, their capacity to serve special needs populations, and related political, historical, administrative, and regulatory considerations, to...

This new study shows that Medicare beneficiary information-gathering behavior and experience with Medicare managed care were more highly associated with knowledge about Medicare managed care than formal education, age, income, or membership in a managed care plan before enrolling in Medicare....

Based on case studies in seven states, examines three critical questions about Medicaid managed care: 1) Does experience with it facilitate program operations? 2) Can it deliver on important goals? 3) Can states extend it beyond low-income families and children to others? Notes that it may be a...

Reviews federal and state oversight of section 1115 Medicaid managed care demonstrations in HI, OK, RI, and TN, functions that barely existed in fee-for-service Medicaid. Notes that monitoring has improved over time but is not yet ensuring access and quality.