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Contracting for Medicaid managed care.

Davidson Hl

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Abstract

State and Federal officials are turning to managed care to help control the costs of providing healthcare services to Medicaid recipients. However, most managed care plans and providers have little experience with this unique population. The socioeconomic profile, medical needs, healthcare utilization, and cost patterns of Medicaid recipients are very different from those of the commercial population. Managed care plans and providers that want to participate in Medicaid managed care programs must develop new approaches to providing benefits and developing capitation rates.

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What this paper is about

State and Federal officials are turning to managed care to help control the costs of providing healthcare services to Medicaid recipients. However, most managed care plans and providers have little experience with this unique population. The socioeconomic profile, medical needs, healthcare utilization, and cost patterns of Medicaid recipients are very different from those of the commercial population. Managed care plans and providers that want to participate in Medicaid managed care programs must develop new approaches to providing benefits and developing capitation rates.

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Available abstract

State and Federal officials are turning to managed care to help control the costs of providing healthcare services to Medicaid recipients. However, most managed care plans and providers have little experience with this unique population. The socioeconomic profile, medical needs, healthcare utilization, and cost patterns of Medicaid recipients are very different from those of the commercial population. Managed care plans and providers that want to participate in Medicaid managed care programs must develop new approaches to providing benefits and developing capitation rates.

Key concepts: Medicaid, Capitation, Managed care, Medicaid managed care, Business, Health care, Population, Medicine

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