RESUMEN
Tennessee created TennCare in 1994 to address the needs of "poor and uninsured citizens ... excluded from the health care system." Under TennCare, Tennessee implemented managed care in its Medicaid program and used savings anticipated from the switch to expand insurance coverage to uninsured and uninsurable adults and children. Our analysis of the expansion suggests that it improved access to care, reduced unmet need, and encouraged use of preventive services, particularly for children. These changes coincided with higher levels of satisfaction with care among TennCare beneficiaries.
Asunto(s)
Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Programas Controlados de Atención en Salud/estadística & datos numéricos , Medicaid/organización & administración , Pacientes no Asegurados/estadística & datos numéricos , Satisfacción del Paciente/estadística & datos numéricos , Planes Estatales de Salud/organización & administración , Adulto , Niño , Encuestas de Atención de la Salud , Estado de Salud , Humanos , Pobreza/estadística & datos numéricos , Evaluación de Programas y Proyectos de Salud , Factores Socioeconómicos , Tennessee/epidemiología , Estados UnidosRESUMEN
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.
Asunto(s)
Programas Controlados de Atención en Salud/normas , Medicaid/normas , Planes Estatales de Salud/normas , Centers for Medicare and Medicaid Services, U.S. , Eficiencia Organizacional , Accesibilidad a los Servicios de Salud , Humanos , Programas Controlados de Atención en Salud/economía , Programas Controlados de Atención en Salud/organización & administración , Medicaid/economía , Medicaid/organización & administración , Proyectos Piloto , Evaluación de Programas y Proyectos de Salud , Calidad de la Atención de Salud , Planes Estatales de Salud/economía , Planes Estatales de Salud/organización & administración , Estados UnidosRESUMEN
This article reviews the experiences of federally qualified health centers (FQHCs) in Hawaii, Rhode Island, and Tennessee before and after Medicaid managed care demonstrations began. Adapting to managed care proved challenging, but all FQHCs survived. Overall, FQHCs performed better financially than anticipated, partly because demonstrations expanded coverage to previously uninsured individuals, and because FQHCs in two States formed plans that paid FQHCs more than other plans. Service encounters declined; it is unclear if this is negative, since it may indicate more efficient care delivery. In some cases, supportive State policies aided FQHCs' survival. Continued adaptation is critical for FQHCs' longer term prospects.
Asunto(s)
Programas Controlados de Atención en Salud/organización & administración , Medicaid/organización & administración , Planes Estatales de Salud/organización & administración , Centros Comunitarios de Salud/economía , Centros Comunitarios de Salud/organización & administración , Determinación de la Elegibilidad , Hawaii , Accesibilidad a los Servicios de Salud , Humanos , Renta , Programas Controlados de Atención en Salud/economía , Medicaid/economía , Proyectos Piloto , Evaluación de Programas y Proyectos de Salud , Rhode Island , Planes Estatales de Salud/economía , Tennessee , Estados UnidosRESUMEN
Interviews with state Medicaid officials reveal that although managed care programs have been implemented in rural areas, participation remains behind that of urban areas. Many states aim to create a statewide Medicaid managed care program and are struggling to overcome barriers that are greater in rural areas, including providers' resistance, lack of commercial managed care, and inadequate supply of providers. Many have modified contracting strategies and shown flexibility regarding interpretations of travel standards, twenty-four-hour coverage requirements, and primary care case management requirements, to implement programs in rural environments.