Commercial plans in medicaid managed care: Understanding who stays and who leaves

Health Affairs

Volumn 24, Issue 4, 2005, Pages 1084-1094

  Long, Sharon K ^a   Yemane, Alshadye ^a  

^a URBAN INSTITUTE   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; CAPITATION FEE; ECONOMIC ASPECT; ECONOMICS; EPIDEMIOLOGY; HEALTH CARE COST; HEALTH CARE PLANNING; HEALTH INSURANCE; HUMAN; MANDATORY PROGRAM; MEDICAID; ORGANIZATION; ORGANIZATION AND MANAGEMENT; RISK; STATISTICS; UNITED STATES; UTILIZATION REVIEW;

CAPITATION FEE; DECISION MAKING, ORGANIZATIONAL; ECONOMIC COMPETITION; HEALTH CARE SECTOR; HEALTH CARE SURVEYS; HUMANS; MANAGED CARE PROGRAMS; MANDATORY PROGRAMS; MEDICAID; ODDS RATIO; STATE HEALTH PLANS; UNITED STATES; UTILIZATION REVIEW;

EID: 23044502541     PISSN: 02782715     EISSN: None     Source Type: Journal    
DOI: 10.1377/hlthaff.24.4.1084     Document Type: Article

References (24)

1. Centers for Medicare and Medicaid Services, "Managed Care Trends," 1996-2003, www.cms.hhs.gov/medicaid/managedcare/trends03.pdf (13 April 2005).
2. Managed Care Trends 1996 2003, www.cms.hhs.gov/medicaid/managedcare/ trends03.pdf Ibid.;
3. and S. Felt-Lisk, R. Dodge, and M. McHugh, Trends in Health Plans Serving Medicaid - 2000 Data Update (Washington: Kaiser Commission on Medicaid and the Uninsured, 2001).
4. This definition of commercial plans, which has been used in earlier work on plan MMC participation, is based on the old "75/25 rule," which required that health plans serving Medicaid beneficiaries have at least 25 percent of their enrollees be non-Medicaid beneficiaries. The rule was eliminated in the Balanced Budget Act (BBA) of 1997.
5. S. Felt-Lisk, The Changing Medicaid Managed Care Market: Trends in Commercial Plans' Participation (Washington: Kaiser Commission, 1999);
6. and Felt-Lisk et al., Trends in Health Plans Serving Medicaid.
7. See, for example, M.J. McCue et al., "Reversal of Fortune: Commercial HMOs in the Medicaid Market," Health Affairs 18, no. 1 (1999): 223-230;
8. T.A. Coughlin, S.K. Long, and J. Holahan, "Commercial Health Plan Participation in Medicaid Managed Care: An Examination of Six Markets," Inquiry 38, no. 1 (2001): 22-34;
9. and D.A. Draper, R.E Hurley, and A.C. Short, "Medicaid Managed Care: The Last Bastion of the HMO?" Health Affairs 23, no. 2 (2004): 155-167.
10. Although we do not have information on all Medicaid-dominated plans in our database, we compared the exit behavior of the Medicaid-dominated plans in our data with that of commercial plans. We found significant differences in the factors associated with MMC exits for the two types of plans.
11. Most recently, M.P. Glavin et al., "An Examination of Factors in the Withdrawal of Managed Care Plans from the Medicare+Choice Program," Inquiry 39, no. 4 (2002-03): 341-354;
12. and T. Lake and R. Brown, Medicare+Choice Withdrawals: Understanding Key Factors (Menlo Park, Calif.: Henry J. Kaiser Family Foundation, 2001).
13. This model assumes that the plan makes the decision on whether to continue participating in Medicaid managed care in a particular county. It should be noted that in some cases, states make a decision to not renew a contract for a plan in a particular market. We cannot distinguish between exits that are a result of a decision by the plan and exits that are by state choice.
14. For information on the InterStudy data, see InterStudy "Competitive Edge," www.hmodata.com/ISHMOCompetitiveEdge.asp (12 May 2005).
15. Data for the average premium for employer coverage came from Medical Expenditure Panel Survey (MEPS) and County Business Patterns (CBP) data. MEPS provides single and family premium data by state and firm-size category. CBP provides the share of workers in a given firm-size category. The measure of county-level premiums is constructed by multiplying the share of workers in each firm-size category in the county with the corresponding premium data for that firm-size category in the state and summing up the values across the firm-size categories for the county.
16. CMS, "Announcement of Calendar Year (CY) 2000 Medicare+Choice Payment Rates," 1 March 1999, www.cms.hhs.gov/healthplans/rates/2000/cover- 00.asp (13 April 2005).
17. J. Holahan and S. Suzuki, "Medicaid Managed Care Payment Methods and Capitation Rates in 2001," Health Affairs 22, no. 1 (2003): 204-218.
18. Exhibit 3 reports one-half standard deviation of the standardized growth rate (which is constructed as each state's growth rate divided by the mean growth rate across all states). For ease of interpretation, we report the change in terms of percentage points in the text.
19. See, for example, A. Leibowitz, J.L. Buchanan, and J. Mann, "A Randomized Trial to Evaluate the Effectiveness of a Medicaid HMO," Journal of Health Economics 11, no. 3 (1992): 235-257.
20. I. Moscovice, M. Casey, and S. Krein, "Expanding Rural Managed Care: Enrollment Patterns and Prospects," Health Affairs 17, no. 1 (1998): 172-179.
21. Coughlin et al., "Commercial Health Plan Participation."
22. Glavin et al., "An Examination of Factors";
23. and Lake and Brown, Medicare+Choice Withdrawals.
24. Felt-Lisk et al., Trends in Health Plans Serving Medicaid.