Context.— Enrollment in Medicaid managed care plans has increased more than 5-fold
in this decade, but how states monitor and encourage quality of care in these
programs is not known.
Objective.— To characterize the quality monitoring and assurance activities of state
Medicaid agencies for Medicaid beneficiaries enrolled in comprehensive prepaid
managed care programs.
Design.— Structured telephone survey conducted between October 1996 and January
Setting.— State Medicaid agencies.
Participants.— Representatives from all state Medicaid agencies, including the District
of Columbia, with beneficiaries enrolled in comprehensive prepaid managed
care plans as of July 1, 1996.
Main Outcome Measures.— Proportion of states with specific quality monitoring and assurance
activities for Medicaid managed care.
Results.— We surveyed all 34 states enrolling beneficiaries in comprehensive managed
care programs. In 1996, all 34 states enrolled the population receiving assistance
from the Aid to Families With Dependent Children (AFDC) program, while only
21 (62%) and 15 (44%) enrolled the disabled and elderly populations, respectively.
In the period 1995 to 1996, 19 states (63%) collected data on satisfaction
with care, and 25 states (83%) collected data on childhood immunizations.
No more than half of the states collected data on other selected measures
of access and quality, but a substantial number planned to collect such data
in 1997. While at most 37% of states were providing comparative data to health
plans, up to 80% were planning to provide such information in 1997. Similarly,
while at most 10% of states provided beneficiaries with such information,
up to 38% planned to do so in 1997. The breadth of contracting requirements
designed to assure quality varied substantially across states.
Conclusions.— State Medicaid agencies have already begun adapting to their new roles
as purchasers of health care. Continued monitoring is essential to ensure
that state agencies implement planned programs and that quality of care for
Medicaid enrollees is preserved or improved.