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Review
. 2000 Winter;22(2):61-83.

Perils of pioneering: monitoring Medicaid managed care

J Wooldridge  1 , S D Hoag
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Review

Perils of pioneering: monitoring Medicaid managed care

J Wooldridge et al. Health Care Financ Rev. 2000 Winter.

Abstract

This article reviews Federal and State oversight of section 1115 Medicaid managed care demonstrations in Hawaii, Oklahoma, Rhode Island, and Tennessee from 1994 to 1998. Under Medicaid managed care, the Federal Government and States have had to shift their focus and resources into oversight functions that barely existed in fee-for-service (FFS) Medicaid. We find that managed care monitoring was slow to begin and not always adequate in these demonstrations. While State and Federal monitoring have improved over time, monitoring is not yet at the point of ensuring access and quality.

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Figure 1
Figure 1. Framework for Monitoring
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References

    1. Birch and Davis Health Management Corporation. Plan for Monitoring RIte Care Health Plans. Birch and Davis; Cranston, RI.: May, 1996a. Prepared for the Rhode Island Office of Managed Care, Department of Human Services.
    1. Birch and Davis Health Management Corporation. RIte Care 1996 Access Study Final Report. Birch and Davis; Cranston, RI.: Mar, 1996b. Prepared for the Rhode Island Office of Managed Care, Department of Human Services.
    1. Federal Register. Medicaid Program; Medicaid Managed Care; Proposed Rule. Federal Register. 1998 Sep 29;63(188):52022. - PubMed
    1. FMH, Inc. Hawaii Health QUEST Medical Early Periodic Screening, Diagnosis, and Treatment Program Study Report. Oct, 1997. Prepared for Med-QUEST Division, Hawaii Department of Human Services.
    1. Health Care Financing Administration. Draft Monitoring Response to Hawaii. Baltimore, MD.: Aug, 1997.

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