Changes in Health Plans Serving Medicaid, 1993-1996

Health Affairs

Volumn 16, Issue 5, 1997, Pages 125-133

  Felt Lisk, Suzanne ^a   Yang, Sara ^b  

^a MATHEMATICA POLICY RESEARCH   (United States)

^b NONE

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; CAPITATION FEE; HEALTH MAINTENANCE ORGANIZATION; HUMAN; INFORMATION PROCESSING; MEDICAID; STATISTICAL ANALYSIS; STATISTICS; UNITED STATES; UTILIZATION REVIEW;

CAPITATION FEE; DATA COLLECTION; DATA INTERPRETATION, STATISTICAL; HEALTH MAINTENANCE ORGANIZATIONS; HUMANS; MEDICAID; UNITED STATES;

EID: 0008603466     PISSN: 02782715     EISSN: None     Source Type: Journal    
DOI: 10.1377/hlthaff.16.5.125     Document Type: Review

References (17)

1. U.S. General Accounting Office, States Turn to Managed Care to Improve Access and Control Costs, GAO/HRD-93-46 (Washington: GAO, March 1993).
2. J. Gabel et al., "Growing Diversification in HMOs, 1988-1994," Medical Care Research and Review (March 1997): 101-117.
3. Other characteristics of interest for which we did not have data for many plans included for-profit/not-for-profit status, extent of service to urban versus rural enrollees, and characteristics of a plan's provider network.
4. Because CalOptima is the largest of the full-risk health-insuring organizations (HIOs) and thus potentially has a significant effect on our results, we obtained data from the organization on which plans it subcontracts with on a full-risk basis and their enrollment each year. It is likely that one or more of the other smaller HIOs also subcontracts with full-risk plans, in which case our figures may slightly underestimate the number of full-risk plans serving Medicaid.
5. J. Corrigan et al., "Trends toward a National Health Care Marketplace," Inquiry (Spring 1997): 11-28.
6. Because we used mostly InterStudy data rather than AAHP data for 1996, the total enrollment data for 1996 are for 1 January 1996, rather than 31 December 1995. This could affect the results since reenrollment occurs irregularly and in the commercial market is particularly extensive in January of each year. However, we did not view this as a major problem, given our focus on large differences in types of plans. In a few cases, where the AAHP and InterStudy data appeared to conflict because of reporting differences, we were able to substitute total enrollment for 31 December 1995 from prepublication data.
7. Bureau of Primary Health Care, Health Resources and Services Administration, U.S. Department of Health and Human Services, unpublished data, March 1997.
8. HCFA enrollment data only included an indicator for SSI service in 1995, not other years. Plans that are subcontractors to CalOptima in California are excluded from this analysis because we do not have HCFA data indicating whether or not they serve the SSI population.
9. Medicaid-dominated plans were likely formed to serve Medicaid, so excluding them from this analysis gives the reader a better sense of the extent to which health plans with other options are participating in Medicaid.
10. The apparent trend toward enrollment in larger plans is a function of the national growth trend in plans rather than a change in where beneficiaries tend to enroll. (We examined this by reanalyzing the trend using plan sizes that were standardized for the national growth trend in total enrollment.)
11. The increase in participation was not attributable to a few major health plan systems' shifting all of their health plans into Medicaid managed care. The data show that plans that are affiliated with a particular system do not tend to move in or out of the Medicaid market all at one time.
12. Twenty-four of the eighty-nine new Medicaid-only plans that began operations in 1994 or 1995 grew to 20,000 or more members by 1996.
13. Those for whom Medicaid enrollment comprises less than 75 percent of their total enrollment.
14. There are several potential types of Medicaid-only plans, but these types are not identified in current data sources. At least twenty-four plans nationally are owned or operated at least in part by community health centers, and most of these are Medicaid-only plans. Bureau of Primary Health Care, unpublished data, March 1997. Other Medicaid-only plans may be run by commercial health plans. A commercial plan may, for example, establish a Medicaid-only plan in a state where it does not have a commercial health plan. Or it may license a Medicaid product separately from its commercial product. We recombined this latter type of plan, even when listed separately in an industry directory, so that it was counted as a commercial-based plan.
15. S. Felt-Lisk and R. St. Peter, The Quality Assurance Reform Initiative (QARI) Demonstration for Medicaid Care: Final Evaluation Report (Washington: The Henry J. Kaiser Family Foundation, November 1996). In the evaluation, which involved twenty-one health plans in three states, the plans with less-developed quality systems tended to be Medicaid-dominated plans.
16. Health Care Financing Administration, A Health Care Quality Improvement System for Medicaid Managed Care: A Guide for States (Washington: U.S. Department of Health and Human Services, July 1993).
17. Felt-Lisk and St. Peter, The Quality Assurance Reform Initiative.