By Joe Touschner

Managed care has been part of the Medicaid landscape for many years.  Those of us who focus on children and families enrolled in Medicaid are particularly familiar with it—the overwhelming majority of kids in Medicaid are in managed care as are most of the adults who are not elderly or experiencing disabilities.  And recently there has been renewed interest in moving more Medicaid beneficiaries into managed care plans—states have been taking steps to serve aged beneficiaries and those with disabilities using managed care and it’s likely that states that extend Medicaid to more adults in 2014 will do so with managed care.

So what have we learned from Medicaid’s experience with managed care?  And what will be the issues moving forward as new populations use it?  Two new reports help to answer these questions.

Michael Sparer examined Medicaid’s experience with managed care for the Robert Wood Johnson Foundation.  He found that there is little evidence of national savings from Medicaid managed care, though a few states have experienced modest savings.  These were more likely to be states with initially higher fee-for-service payments.  Sparer also found mixed success by managed care plans in improving access to care while their effects on quality of care for enrollees have not been well studied.

While the RWJF report looks back, a Kaiser Commission on Medicaid and the Uninsured paper looks ahead and identifies emerging issues in Medicaid managed care.  KCMU gathered a roundtable of experts to discuss managed care provider networks, bringing managed care to populations it has not traditionally covered, and the 2014 expansion.  The report finds that MCO provider networks reflect the make-up of current enrollees—mostly children and parents; that payment methods vary; and that beneficiaries’ access to providers faces similar challenges to patients outside Medicaid.  Expanding managed care to individuals with disabilities and those who are aged will require plans to alter their networks and require states to be smart in collecting data and overseeing plan contracts.  Looking ahead to 2014, the roundtable saw opportunities for Medicaid managed care plans to help contribute to aligned coverage between Medicaid and exchanges, but recognized many challenges standing in the way of managed care plans gaining certification as qualified health plans.

Managed care will continue to play a big role in providing coverage to Medicaid beneficiaries.  As policymakers weigh changes in who it covers and how it works, it’s important to look at the evidence in Sparer’s report to recognize the limited evidence on what managed care can achieve in the areas of cost, access, and quality.  The Kaiser report, too, can help in identifying key questions to raise as managed care changes go forward.