Last week, the Kaiser Commission on Medicaid and the Uninsured released its “Profile of Medicaid Managed Care Programs in 2010: Findings from a 50-State Survey.”
Nearly all privately insured Americans have been in managed care plans for a couple decades, but Medicaid has been a laggard. It’s catching up. About three-fourths of all Medicaid members nationally now get their care through private insurance carriers, up from just 16% in 2003. In Tarrant County, all children on Medicaid and CHIP get their care either through Aetna, Amerigroup or Cook Children’s Health Plan. For example, Amerigroup is the state’s largest Medicaid managed care plan with nearly half a million members. Those plans, in turn, contract with local doctors, hospitals, dentists, labs, etc.
Outsourcing the management of Medicaid care should ensure more coordinated care for the patient as well as more predictable cost for the state. That’s the goal. Of course, if you really wanted coordinated care, you wouldn’t make families re-enroll every 6 months. Of Medicaid managed care states, 27 have 12-month continuous eligibility for children. Texas is one of 10 that has six-month eligibility.
However, while states have moved to a common strategy — contracting with private insurers for Medicaid — there are big differences in how they do it.
For example, when a family enrolls in for Medicaid, they’re asked to select a private plan. If they don’t, they’re assigned one. How, you may ask? The Kaiser report shows that there are 11 criteria that states use. Texas uses six, such as if the person had a previous plan or related member in the plan. Unlike some states, Texas doesn’t consider plan quality ratings, though.
Another interesting comparison was access. Every state defines access for its Medicaid population. You know how you hear about how few physicians take Medicaid patients? Well, Medicaid private plans must ensure they have enough physicians to serve their members, and the state decides the minimum threshold. For example, in Hawaii, the Medicaid plans must have contracts with one primary care doctor for every 600 members. In Illinois, it’s one for every 1,200 members. In Texas, patients must be able to access one primary care doctor within 30 miles; one specialist within 75 miles. Wow — that’s a long way to go to see a specialist.
Also, according to the report, Texas is one of the states that publicly releases quality and patient experience data for its Medicaid plans. That was news to me. I’ve asked the state to point me to where I can read those.
So, this leads to something else that happened last week. Texas and the federal government “reached agreement in principle” to let the state expand Medicaid managed care across the state and create funding pools to finance hospital infrastructure and quality improvement programs. You see, as the state has moved more people to managed Medicaid, it screwed up some of the federal funding formulas. The waiver smooths that out.
But, here’s the other interesting part. In the waiver proposal, the state also says it wants to ensure Texas is “ready to serve newly insured individuals who would enroll in Medicaid or federally subsidized insurance under current law starting in 2014.”
So, even though Texas is suing in federal court to block the health reform law, it’s asking for help to conform. That’s called hedging your bets.