Medicaid Reform: Legislature Should Delay Expansion Until More Information Is Available to Evaluate Success
Report 09-29, June 2009
- Medicaid Reform, implemented in August 2006, is intended to empower beneficiaries to take an active role in their health care. Medicaid Reform offers beneficiaries a choice among managed care options; guidance in selecting a health plan that meets their needs; and monetary incentives to increase healthy behaviors. Reform also is intended to encourage managed care plans to enroll sicker beneficiaries by paying plans based on the health status of the persons they serve. Overall, Reform is expected to improve beneficiaries' access to and quality of health care services.
- Through December 2008, the state spent $37.8 million to implement and administer Medicaid Reform. Most of these costs (94%) paid vendors to administer and operate the choice counseling, opt-out, and enhanced benefits components; to evaluate the pilot per waiver requirements; and to develop and manage other Medicaid Reform requirements such as health plan contracts, benefit package design, risk-adjusted payment rates, and other technical support. The remaining 6% paid for Agency for Health Care Administration personnel salaries and benefits associated with Reform activities.
- To date, little data is available to demonstrate that Medicaid Reform has improved access to and quality of care. While AHCA has developed a system to track services provided to beneficiaries, this system will not have complete plan service data available until January 2010. In addition, little data is yet available on whether Medicaid Reform has produced cost savings or is more cost-effective than traditional Medicaid. We recommend that the Legislature not expand Medicaid Reform until more information is available to evaluate success.
Medicaid Reform: Reform Provider Network Requirements Same as Traditional Medicaid; Improvements Needed to Ensure Beneficiaries Have Access to Specialty Providers
Report 08-64 November 2008
Medicaid Reform: Oversight to Ensure Beneficiaries Receive Needed Prescription Drugs Can Be Improved; Information Difficult for Beneficiaries to Locate and Compare
Report 08-55 September 2008
Medicaid Reform: Risk-Adjusted Rates Used to Pay Medicaid Reform Health Plans Could Be Used to Pay All Medicaid Capitated Plans
Report 08-54 September 2008
Medicaid Reform: Choice Counseling Goal Met, But Some Beneficiaries Experience Difficulties Selecting a Health Plan That Best Meets Their Needs
Report 08-46 July 2008
Medicaid Reform, Reform costs, quality of care, Reform expansion, Medicaid, opt-out, risk-adjusted rates, provider networks, enhanced benefits, choice counseling, benefits packages, Medicaid managed care, Medicaid provider service networks,