The Centers for Medicare and Medicaid Services last week introduced a final Medicaid managed care rule establishing a new regulatory framework for the next generation of managed care. A policy watershed, the rule ultimately will touch the lives of tens of millions of low-income children and adults, and individuals with disabilities. Estimates suggest that a majority of today’s 72 million Medicaid beneficiaries are enrolled in managed care plans in 40 states (including the District of Columbia), and the number is expected to increase over the next decade.
The rule places states in the driver’s seat of an undertaking that is not for the faint of heart. As explained in a still-relevant 1997 landmark study, states have been working toward creating entire health care delivery systems for their Medicaid managed care beneficiaries. As they tackle everything from marketing and enrollment to quality improvement in service delivery and creating relationships with social service programs, states face unique challenges because of whom they serve and the level of coverage and service integration that managed care must be structured to achieve.
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