Incentives in a Specialty Care Carve-Out
Abstract
Most state Medicaid agencies are turning to capitated prepayment to contain costs, to improve access to care, and to increase efficiency in the provision of services. However, many states have concerns about how the financial incentives that accompany prepaid care could affect services to chronically ill beneficiaries. Medicaid agencies are implementing a variety of prepayment strategies specifically for children with chronic conditions, often intended to reduce financial disincentives for providing adequate care. They range from excluding certain services, to allowing voluntary enrollment in prepaid health plans for some children while requiring others to enroll. Some have questioned how these different policies will affect provider behavior, and how this in turn will affect the care that a child receives. California implemented a set of dramatic changes to the delivery of health care to Medicaid beneficiaries during the 1990's. Much of the policy debate over access to services focused on how to preserve specialty care access for children with complex medical diagnoses while also improving access to primary care to the general population. As California's ambitious plan to expand managed care unfolded in its largest counties, a legislative effort preserved the traditional role of the Social Security Act, Title V Children with Special Health Care Needs program in authorizing services under the traditional fee-for-service system. Child Medicaid beneficiaries who are eligible for Title V are those with complex medical diagnoses.
Document Details
- Document Type
- Technical Report
- Publication Date
- Jan 01, 2001
- Accession Number
- ADA392635
Entities
People
- Moira Inkelas
Organizations
- RAND Corporation