A leading expert in Medicaid managed care said states that rush transition to it inevitably experience disastrous consequences.
Sara Rosenbaum, chair of the Department of Health Policy at George Washington University, said every state that has gone to managed care has experienced bumps along the way, even those that have allowed for adequate planning and transition time.
“In other states, the rush into managed care has gone too fast,” said Rosenbaum, who has co-authored several studies on managed care contracting.
She said in the early days of Arizona’s move to Arizona Access and Tennessee’s move to TennCare, things went particularly badly.
“Things happened too fast and thousands of people didn’t get connected properly with care and there was mass confusion and serious gaps in health care,” she said. “The big thing often is that you dump a lot of people into plans that don’t have enough capacity. That’s the biggest concern.”
She said that as a starting point, Kansas’ timeline was prudent.
“Two months to respond to the RFP is acceptable, and the year lead-in time is essential for planning,” Rosenbaum said.
She said other potential pitfalls were poorly structured contracts, poor alignment between states and companies about rights and responsibilities, and cases where patients don’t understand what is expected of them.
When the problems occur, they fall hard on Medicaid beneficiaries, she said.
“A lot of people — particularly people with serious health conditions — may have gone without appropriate levels of care, where there was not enough accountability, where the companies themselves were unhappy with the involvement of the state,” she said.
She said states that experienced smoother transitions — such as Minnesota, Wisconsin, Oregon, Washington, Massachusetts, and Connecticut — were careful about how they developed and oversaw contracts, and about how people were transitioned into managed-care arrangements.
“These things can work quite well or they can be quite disastrous, depending on how well the state does its job,” Rosenbaum said. “If a state is trying to get this all done in a few weeks, it’s not going to go well.”
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